Abstract

The treatment for heart failure (CHF) due to diastolic dysfunction is not established. We conducted a pilot study on the effect of β-blockade on diastolic heart failure in the elderly.

18 subjects (15 women, 3 men; age 68±10 years) with fatigue or dyspnea on exertion not due to pulmonary disease and with normal systolic function were randomized to receive a β-blocker metoprolol XL or a placebo for 9 months, in addition to their medications. Heart failure scores, 6-min walk distance, 24-hour blood pressure (BP) and echocardiographic parameters were compared in the two groups at baseline and at 9 months.

Modified NHANES heart failure score improved significantly in the β-blocker group. 24-hour BP was not significantly different at baseline between the groups, and both groups had similar reductions in BP at 9 months. There was no significant change in 6-min walk or NYHA heart failure class in either group. Doppler E/A ratio tended to improve in the metoprolol XL group.

In summary, this data demonstrates that elderly subjects with CHF due to diastolic dysfunction can be identified and treated, and that β-blocker therapy improves signs and symptoms of CHF in this population. This pilot study provides the rationale for a large-scale trial of β-blockade in diastolic dysfunction. (See Table)

PlaceboMetoprolol XL
Baseline9 monthsPBaseline9 monthsP
24-hour BP, mmHg131 ± 16/ 77 ± 16116 ± 12/ 69 ± 6NS148 ± 19/ 83 ± 10133 ± 11/ 73 ± 7NS/ 0.009
6 min walk, ft1007 ± 3021036 ± 265NS1005 ± 305991 ± 381NS
E/A ratio0.74 ± 0.140.73 ± 0.15NS0.52 ± 0.210.69 ± 0.16NS
NYHA class2.4 ± 0.52.3 ± 0.8NS2.3 ± 0.52.0 ± 0.6NS
NHANES Score3.7 ± 0.82.7 ± 1.2NS3.8 ± 1.02.2 ± 0.80.025
PlaceboMetoprolol XL
Baseline9 monthsPBaseline9 monthsP
24-hour BP, mmHg131 ± 16/ 77 ± 16116 ± 12/ 69 ± 6NS148 ± 19/ 83 ± 10133 ± 11/ 73 ± 7NS/ 0.009
6 min walk, ft1007 ± 3021036 ± 265NS1005 ± 305991 ± 381NS
E/A ratio0.74 ± 0.140.73 ± 0.15NS0.52 ± 0.210.69 ± 0.16NS
NYHA class2.4 ± 0.52.3 ± 0.8NS2.3 ± 0.52.0 ± 0.6NS
NHANES Score3.7 ± 0.82.7 ± 1.2NS3.8 ± 1.02.2 ± 0.80.025

Data are mean ± SD.

PlaceboMetoprolol XL
Baseline9 monthsPBaseline9 monthsP
24-hour BP, mmHg131 ± 16/ 77 ± 16116 ± 12/ 69 ± 6NS148 ± 19/ 83 ± 10133 ± 11/ 73 ± 7NS/ 0.009
6 min walk, ft1007 ± 3021036 ± 265NS1005 ± 305991 ± 381NS
E/A ratio0.74 ± 0.140.73 ± 0.15NS0.52 ± 0.210.69 ± 0.16NS
NYHA class2.4 ± 0.52.3 ± 0.8NS2.3 ± 0.52.0 ± 0.6NS
NHANES Score3.7 ± 0.82.7 ± 1.2NS3.8 ± 1.02.2 ± 0.80.025
PlaceboMetoprolol XL
Baseline9 monthsPBaseline9 monthsP
24-hour BP, mmHg131 ± 16/ 77 ± 16116 ± 12/ 69 ± 6NS148 ± 19/ 83 ± 10133 ± 11/ 73 ± 7NS/ 0.009
6 min walk, ft1007 ± 3021036 ± 265NS1005 ± 305991 ± 381NS
E/A ratio0.74 ± 0.140.73 ± 0.15NS0.52 ± 0.210.69 ± 0.16NS
NYHA class2.4 ± 0.52.3 ± 0.8NS2.3 ± 0.52.0 ± 0.6NS
NHANES Score3.7 ± 0.82.7 ± 1.2NS3.8 ± 1.02.2 ± 0.80.025

Data are mean ± SD.

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