Pharmacological therapy for hypertrophic cardiomyopathy: what is the evidence for success?

The available experience from studies of pharmacological treatment of patie nts with hypertrophic cardiomyopathy was mainly gained in selected patient samples, with severe symptoms or a complicated clinical setting. Moreover. most reports on drug efficacy are based on either acute mechanistic studies or non-controlled patient cohorts. which are usually rather restricted in numbers and followed for limited periods of time, Bearing in mind the sympt omatic presentation of hypertrophic cardiomyopathy, which is sometimes high ly variable and influenced to a degree by sympathetic arousal, it is unders tandable that a considerable placebo effect may occur when initiating any t ype of treatment. Considering the pathophysiology that underlies symptoms o f hypertrophic cardiomyopathy, it is not surprising that the pharmacologica l agents that are most advocated are beta-blockers and calcium channel bloc kers drugs that impact on several of the factors that are responsible for t he symptoms. Other compounds that may be used include antiarrhythmic drugs, of which disopyramide combining antiarrhythmic with negative inotropic pro perties has attracted particular interest. (C) 2001 The European Society of Cardiology.