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CLINICAL EFFICACY OF A BETABLOCKERS THERAPY IN PATIENTS WITH CHRONIC HEART FAILURE ON THE BACKGROUND OF POSTINFARCTION CARDIOSCLEROSIS

Despite the fact that betablockers (BBs) are one of the main groups of therapy of patients with acute myocardial infarction (AMI), the comparative effectiveness of various BBs in patients with postinfarction cardiosclerosis (PICS) is uncertain. There was performed comparative analysis of clinical efficacy of BBs in patients with chronic heart failure (CHF) on the background of coronary heart disease (CHD), PICS. There was evaluated the impact of metoprolol succinate, carvedilol, bisoprolol and betaxolol on blood pressure (BP), left ventricular ejection fraction (LVEF), change the functional class of chronic heart failure, and mortality in patients over 4 years. It is established that the BBs therapyblood pressure decreased equally, without significant differences between the groups (р˃0,05). There was a positive effect on the increase of the LVEF all the BBs (p<0.01), bisoprolol was exerted more pronounced effect (p<0.01). Comparative assessment of BBseffectiveness showed that the reducti0on of the functional class of chronic heart failure was in the bisoprolol treatment by 43.7% (p<0.001), carvedilol by 32.3% (p<0.001), betaxolol by 27.3% (p<0.01) and metoprolol succinate by 25.6% (p<0.01). Differences between groups were significant in favor of bisoprolol. Also, our study investigated the influence of BB streatment on the mortality of patients with CHD, PICS, which was performedby year for 4 years. Depending on the duration of observation for 1year mortality was 7.4% for 2 years it was 11.6%, for 3 years it was 10.5%, for 4 year it was 24.3% (p<0.01 in all cases in comparison with the group without BBs administration). The reduction in mortality associated with treatment with beta blockers during the year was 27.5%, 2 years – 34.8%, 3 years – 67.2% and 4 years 35.9%. Thus, the administration of betablockers can significantly reduce mortality in patients with postinfarction cardiosclerosis, starting from the first year of treatment. And this positive effect persists and accumulates in the future.

Ключевые слова: chronic heart failure, drug therapy, beta blockers, mortality.

Иллюстрации

Table 1. Dynamics of ABP level in the BBS therapy(M±m)

Figure 1. Pharmacodynamic effects of BBS in patients with CHF on the background of coronary heart disease (CHD), postinfarction cardiosclerosis (PICS)

* - р˂0,05 in comparison with baseline group

Figure 2. Pharmacodynamic effects of BBS in patients with CHF on the background of coronary heart disease (CHD), postinfarction cardiosclerosis (PICS). Change the LVEF in the course of the BBS treatment.

Table 3. Changes in functional class of chronic heart failure in patients with CHD, PICS after 12 months of therapy with beta blockers (M±m)

Table 4. Comparative analysis of the influence of BBS therapy on mortality of patients with postinfarction cardiosclerosis

Table 5. Comparative evaluation of the effect of the BBS on mortality of patients with CHD, PICS depending on BBS

DOI: 10.18413/2500-235X-2017-3-1-90-96
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