Efficacy, safety and tolerability of metoprolol CR/XL in patients with diabetes and chronic heart failure: experiences from MERIT-HF.

Abstract

BACKGROUND:

The objective of the current study was to examine the efficacy and tolerability of the beta-blocker metoprolol succinate controlled release/extended release (CR/XL) in patients with diabetes in the Metoprolol CR/XL Randomized Intervention Trial in Chronic Heart Failure (MERIT-HF).

METHODS:

The Cox proportional hazards model was used to calculate hazard ratios (HR) for convenience expressed as relative risks (risk reduction = 1-HR), and 95% confidence intervals (CI).

RESULTS:

The risk of hospitalization for heart failure was 76% higher in diabetics compared to non-diabetics (95% CI 38% to 123%). Metoprolol CR/XL was well tolerated and reduced the risk of hospitalization for heart failure by 37% in the diabetic group (95% CI 53% to 15%), and by 35% in the non-diabetic group (95% CI 48% to 19%). Pooling of mortality data from the Cardiac Insufficiency Bisoprolol Study II (CIBIS II), MERIT-HF, and the Carvedilol Prospective Randomized Cumulative Survival Study (COPERNICUS) showed similar survival benefits in patients with diabetes (25%; 95% CI 40% to 4%) and without diabetes (36%; 95% CI 44% to 27%); test of diabetes by treatment interaction was non-significant. Adverse events were reported more often on placebo than on metoprolol CR/XL.

CONCLUSIONS:

Patients with heart failure and diabetes have a much higher risk of hospitalization than patients without diabetes. Regardless of diabetic status, a highly significant reduction in hospitalizations for heart failure was observed with metoprolol CR/XL therapy, which was very well tolerated also by patients with diabetes. Furthermore, the pooled data showed a statistically significant survival benefit in patients with diabetes.

• Authors: Prakash C Deedwania, Thomas D Giles, Michael Klibaner, Jalal K Ghali, Johan Herlitz, Per Hildebrandt, John Kjekshus, Jindrich Spinar, Jiri Vitovec, Hilary Stanbrook, John Wikstrand, MERIT-HF Study Group
• Journal: American heart journal (Am Heart J) Vol. 149 Issue 1 Pg. 159-67 (Jan 2005) ISSN: 1097-6744 [Electronic] United States
• PMID: 15660048 (Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Adrenergic beta-Antagonists
• Delayed-Action Preparations
• Metoprolol

Topics

• Adrenergic beta-Antagonists (adverse effects, therapeutic use)
• Adult
• Aged
• Delayed-Action Preparations
• Diabetes Complications (drug therapy, mortality)
• Diabetes Mellitus (mortality)
• Double-Blind Method
• Female
• Heart Failure (complications, drug therapy)
• Hospitalization
• Humans
• Male
• Metoprolol (adverse effects, analogs & derivatives, therapeutic use)
• Middle Aged
• Proportional Hazards Models
• Risk
• Survival Analysis