Treatment of heart failure with Celiprolol, a cardioselective beta blockerwith beta-2 agonist vasodilatory properties

Treatment with beta blockers results in improvement in functional status, a nd reduces mortality in patients with heart failure, A number of difference s in the results noted could be due to additional properties of the specifi c beta blockers studied: absence of cardioselectivity, and existence of a v asodilator effect and of an associated antioxidant effect, We studied the e ffects of celiprolol, a cardioselective beta blocker with a stimulant effec t on beta 2 receptors. One hundred thirty-two patients presenting with chro nic heart failure of various etiologies, with an ejection fraction of <40% and New York Heart Association cardiac functional status grades II acid III were included in a randomized, double-blind, placebo-controlled study. The maximum dose of celiprolol (100 mg) was attained after 1 month. The study lasted 1 year. The primary evaluation criterion was functional class as eva luated using the Goldman questionnaire. There was no difference in efficacy between the 2 treatment groups in terms of functional class (p = 0.56). Wi th regard to the secondary evaluation criteria, an improvement in DiBianco functional score was seen with celiprolol (p = 0.03), as well as a signific ant reduction in heart rate (p = 0.01). Ejection fraction increased in both groups (p = 0.15). There was no difference regarding improvement in left v entricular volume as determined at echocardiography or in exercise capacity . The safety profile of celiprolol was excellent. There was no difference i n terms of cardiovascular mortality (2 receiving celiprolol vs 4 placebo), onset of arrhythmias (2 receiving celiprolol vs 3 placebo), worsening of he art failure (26 receiving celiprolol vs 23 placebo), or noncardiovascular a dverse events (9 receiving celiprolol vs 14 placebo). The absence of a sign ificant efficacy of celiprolol, a beta blocker with vasodilator properties, but exerting stimulation of beta 2 receptors, suggests an unfavorable role of this latter property in heart failure. However, the safety profile of c eliprolol was excellent. This beta blocker may consequently be used for its other indications, hypertension and angina, in patients presenting with al tered cardiac function. (C) 2000 by Excerpta Medico, Inc.