Congestive heart failure is a common and serious complication in patients undergoing chronic dialysis. However, there have been no studies on preferential medical
therapies to improve left ventricular function in haemodialysis patients. Beta-blocker treatment is known to improve left ventricular function in patients with
dilated cardiomyopathy; moreover, plasma levels of
noradrenaline and
natriuretic peptides are sensitive markers of
left ventricular dysfunction. The present study investigated whether beta-blocker treatment could improve left ventricular function in haemodialysis patients with a dilated left ventricle. Our study group comprised 14 haemodialysis patients with a dilated left ventricle, who had undergone maintenance haemodialysis for a mean of 11 years. The following haemodynamic parameters were evaluated before and after 4 months of treatment with the beta-blocker
metoprolol: left ventricular dimension at end-systole and end-diastole, and fractional shortening. Plasma levels of
noradrenaline,
atrial natriuretic peptide and
brain natriuretic peptide were also determined. Dry
body weight and haemoglobin concentration showed no significant change after compared with before treatment with
metoprolol. Heart rate decreased significantly, from 79+/-9 beats/min to 69+/-9 beats/min, but systolic blood pressure remained unchanged. The left ventricular dimension both at end-systole and at end-diastole was decreased, and fractional shortening increased significantly. Plasma levels of
noradrenaline did not change significantly, but those of
atrial natriuretic peptide and
brain natriuretic peptide decreased markedly [from 100+/-89 pg/ml to 46+/-29 pg/ml (P=0.0051) and from 549+/-516 pg/ml to 140+/-128 pg/ml (P=0.0035) respectively]. In conclusion, beta-blocker
therapy with
metoprolol can markedly attenuate left ventricular remodelling and decrease the plasma levels of
natriuretic peptides in haemodialysis patients with a dilated left ventricle.