β-blockers in heart failure: benefits of β-blockers according to varying male proportions of study patients

Clinical Cardiology, 04/09/2012

In patients with heart failure (HF), the 3 commonly used b–blockers significantly reduced mortality. Greater benefits of b–blockers were observed in the higher male proportion studies. The metoprolol was significantly superior to carvedilol or bisoprolol in reduced sudden death. Additional trials are required to determine whether the benefits of b–blockers will be observed in female HF patients.

Methods

  • Randomized, placebo controlled clinical trials were included if they evaluated the beneficial effects of the three b–blockers on mortality and on hospital admissions on an intention–to–treat basis, and lasted at least 3 months.

Results

  • 28 trials with 14,829 patients were included.
  • The b–blockers significantly reduced all cause mortality by 29.6%, cardiac death by 29.8%, sudden death by 49.4%, respectively.
  • The magnitude of benefits of b–blockers in HF patients was increased with the increased male proportion.
  • A similar magnitude of reduction in all cause mortality was observed among the three b blockers.
  • A trend toward to reduced cardiac death was observed among the three b blockers, but only in bisoprolol was this statistically different (RR, 0.72; 95%CI, [0.59–0.87]).
  • Metoprolol was significantly superior to carvedilol (P = 0.008) or bisoprolol (P = 0.034) in reduced sudden death.

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