Premium
Tolerability of carvedilol and ACE‐Inhibition in mild heart failure. Results of CARMEN (Carvedilol ACE‐Inhibitor Remodelling Mild CHF EvaluatioN)
Author(s) -
Komajda Michel,
Lutiger Beatrix,
Madeira Hugo,
Thygesen Kristian,
Bobbio Marco,
Hildebrandt Per,
Jaarsma Wybren,
Riegger Günter,
Rydén Lars,
Scherhag Armin,
SolerSoler Jordi,
Remme Willem J.
Publication year - 2004
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1016/j.ejheart.2003.12.019
Subject(s) - carvedilol , tolerability , enalapril , medicine , heart failure , cardiology , adverse effect , ace inhibitor , pharmacology , anesthesia , angiotensin converting enzyme , blood pressure
Background: Management guidelines for heart failure recommend ACE‐I and β‐blockers. The perception of difficult up‐titration might have added to the slow uptake of β‐blockers despite their mortality and morbidity benefits. Aims: CARMEN offered a possibility to study safety and tolerability of enalapril against carvedilol and their combination. Methods: Five hundred and seventy‐two patients were blindly up‐titrated on carvedilol (target 25 mg bid) and/or enalapril (target 10 mg bid), and continued for 18 months. In the combination arm, carvedilol was up‐titrated before enalapril. Results: There was no group related difference in adverse events during up‐titration. Withdrawal rates were 31, 30 and 30%, and serious adverse events 28, 29 and 34% in the combination, carvedilol and enalapril arms. Mortality was similar in all groups (all‐cause N =14, 14 and 14; cardiovascular N =9, 13 and 14). All‐cause and cardiovascular hospitalizations occurred in 26, 27 and 32%, and in 12, 16 and 22% in the combination, carvedilol and enalapril arms, respectively. Conclusion: The safety profile was similar in all treatment arms. In contrast to common perception, there was no difference in tolerability between the ACE‐I and carvedilol. This result is even more remarkable as the high prestudy use of ACE‐I (65%) might have introduced a bias by selecting ACE‐I tolerant patients, who were only switched from their former ACE‐I to enalapril.