© 2004 European Society of Cardiology
Tolerability of carvedilol and ACE-Inhibition in mild heart failure. Results of CARMEN (Carvedilol ACE-Inhibitor Remodelling Mild CHF EvaluatioN)
a Institut de Cardiologie, Centre Hospitalier GH Pitié-Salpêtrière, 47-83 Bld de l'Hôpital 75013, Paris Cedex 13, France
b F. Hoffmann-La Roche Basel, Switzerland
c Hospital de Santa Maria Lisboa, Portugal
d Aarhus University Hospital Aarhus, Denmark
e Hospital Le Molinette Torino, Italy
f Frederiksberg Hospital Frederiksberg, Denmark
g St. Antonius Hospital Nieuwegein, The Netherlands
h University of Regensburg Regensburg, Germany
i Karolinska Hospital Stockholm, Sweden
j University Hospital Vall d'Hebron Barcelona Spain
k Sticares Foundation Rhoon, The Netherlands
* Corresponding author. Tel.: +33-1-42-17-68-14; fax: +33-1-42-17-68-00. E-mail address: Veronique.villareal{at}chups.jussieu.fr
 |
Abstract |
|---|
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.
Key Words: Carvedilol • Enalapril • Heart failure • Tolerability • CARMEN
Received October 10, 2003; Accepted December 10, 2003
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  F. A. McAlister, N. Wiebe, J. A. Ezekowitz, A. A. Leung, and P. W. Armstrong Meta-analysis: {beta}-Blocker Dose, Heart Rate Reduction, and Death in Patients With Heart Failure Ann Intern Med, June 2, 2009; 150(11): 784 - 794. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Hori and K. Nishida Oxidative stress and left ventricular remodelling after myocardial infarction Cardiovasc Res, February 15, 2009; 81(3): 457 - 464. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. R. MacDonald, M. C. Petrie, F. Varyani, J. Ostergren, E. L. Michelson, J. B. Young, S. D. Solomon, C. B. Granger, K. Swedberg, S. Yusuf, et al. Impact of diabetes on outcomes in patients with low and preserved ejection fraction heart failure: An analysis of the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) programme Eur. Heart J., June 1, 2008; 29(11): 1377 - 1385. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. R. MacDonald, M. C. Petrie, N. M. Hawkins, J. R. Petrie, M. Fisher, R. McKelvie, D. Aguilar, H. Krum, and J. J.V. McMurray Diabetes, left ventricular systolic dysfunction, and chronic heart failure Eur. Heart J., May 2, 2008; 29(10): 1224 - 1240. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Chen, R. Chang, B. Umakanthan, L. N. Stoletniy, and J. T. Heywood Improvement of Cardiac Function Persists Long Term With Medical Therapy for Left Ventricular Systolic Dysfunction Journal of Cardiovascular Pharmacology and Therapeutics, September 1, 2007; 12(3): 220 - 226. [Abstract] [PDF]
|
|
|
|
 |
|
 L. R. Goldberg and M. Jessup Stage B Heart Failure: Management of Asymptomatic Left Ventricular Systolic Dysfunction Circulation, June 20, 2006; 113(24): 2851 - 2860. [Full Text] [PDF]
|
|
|
|
 |
|
 J. G.F. Cleland, A. P. Coletta, M. Lammiman, K. K. Witte, H. Loh, M. Nasir, and A. L. Clark Clinical trials update from the European Society of Cardiology meeting 2005: CARE-HF extension study, ESSENTIAL, CIBIS-III, S-ICD, ISSUE-2, STRIDE-2, SOFA, IMAGINE, PREAMI, SIRIUS-II and ACTIVE Eur J Heart Fail, October 1, 2005; 7(6): 1070 - 1075. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Tendera Epidemiology, treatment, and guidelines for the treatment of heart failure in Europe Eur. Heart J. Suppl., October 1, 2005; 7(suppl_J): J5 - J9. [Abstract] [Full Text] [PDF]
|
|