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Carvedilol reduced mortality and hospital admission in severe chronic heart failure, regardless of pretreatment systolic BP
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 Q How does pretreatment systolic blood pressure (SBP) affect the efficacy and safety of carvedilol in patients with severe chronic heart failure (HF)?

Clinical impact ratings IM/Ambulatory care ★★★★★★★ Internal medicine ★★★★★★★ Cardiology ★★★★★★☆

METHODS

Embedded ImageDesign:

randomised controlled trial (Carvedilol Prospective Randomized Cumulative Survival [COPERNICUS] study).

Embedded ImageAllocation:

concealed.*

Embedded ImageBlinding:

blinded (patients and outcome assessors).*

Embedded ImageFollow up period:

mean 10.4 months at early termination of study.

Embedded ImageSetting:

334 centres in 21 countries.

Embedded ImagePatients:

2289 patients (mean age 63 y, 80% men) with severe chronic HF because of ischaemic or non-ischaemic cardiomyopathy; ⩾2 months of dyspnoea or fatigue at rest or on minimal exertion; left ventricular ejection fraction <25%; and SBP >85 mm Hg. Exclusion criteria: correctable cause of HF; heart transplant; severe primary pulmonary, renal, or hepatic disease; contraindications to β blockers; major cardiac event within 2 months; use of α adrenergic blockers, calcium channel blockers, or class I antiarrhythmic drugs within 4 weeks; heart rate <68 beats/minute, serum creatinine concentration >2.8 mg/dl or an increase …

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