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(Circulation. 2001;103:e9049.)
© 2001 American Heart Association, Inc.

Cardiovascular News

Ruth SoRelle, MPH, Circulation Newswriter

ß-Blocker Trials Seem to Be in Conflict

Two studies of ß-blockers in the same issue of the New England Journal of Medicine seem to have conflicting conclusions, but the differences could result from the alternate effects of the drugs studied (N Engl J Med. 2001;344:1659–1667 and N Engl J Med. 2001;344:1651–1658).

The studies were performed in patients with advanced chronic heart failure, whereas previous ß-blocker studies concentrated on patients with mild to moderate heart failure. The first study, the Beta-Blocker Evaluation of Survival Trials (BEST), compared the investigational drug bucindolol with placebo in a randomly assigned group of 2708 patients designated as New York Heart Association functional class III or IV who had ejection fractions 35%. The end point of the study was death from any cause. Interim analyses were performed, and the Data Safety and Monitoring Board recommended ending the study at the seventh such period because no difference in mortality had been identified.

In the second study, researchers randomly assigned 1133 patients to placebo and 1156 patients to treatment with the ß-blocker carvedilol. In this study, 190 patients in the placebo group died compared with 130 in the carvedilol group, a 35% decrease in the risk of death with the ß-blocker. The researchers concluded that treatment with carvedilol had benefit in this population, although "the mechanisms by which carvedilol reduces mortality among patients with heart failure remain unclear." The group, which was led by Milton Packer, MD, of the College of Physicians and Surgeons at Columbia University in New York, noted that . . . [Full Text of this Article]