Document Detail

What resting heart rate should one aim for when treating patients with heart failure with a beta-blocker? Experiences from the Metoprolol Controlled Release/Extended Release Randomized Intervention Trial in Chronic Heart Failure (MERIT-HF).
MedLine Citation:
PMID:  15653024     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: The goal of this study was to explore the question: what resting heart rate (HR) should one aim for when treating patients with heart failure with a beta-blocker? BACKGROUND: The interaction of pretreatment and achieved resting HR with the risk-reducing effect of beta-blocker treatment needs further evaluation. METHODS: Cardiovascular risk and risk reduction were analyzed in five subgroups defined by quintiles (Q) of pretreatment resting HR in the Metoprolol Controlled Release/Extended Release Randomized Intervention Trial in Chronic Heart Failure (MERIT-HF). RESULTS: Mean baseline HR in the 5 Qs were 71, 76, 81, 87, and 98 beats/min; achieved HR 63, 66, 68, 72, and 75 beats/min; and net change -8, -10, -11, -13, and -14 beats/min, respectively. Baseline HR was related to a number of baseline characteristics. Cardiovascular risk was no different in Q1 to Q4 (placebo groups) but increased in Q5 (HR above 90 beats/min). No relationship was observed between the risk-reducing effect of metoprolol controlled release/extended release (CR/XL) and baseline HR in the five Qs of baseline HR, or achieved HR, or change in HR during follow-up, respectively. CONCLUSIONS: Metoprolol CR/XL significantly reduced mortality and hospitalizations independent of resting baseline HR, achieved HR, and change in HR. Achieved HR and change in HR during follow-up were closely related to baseline HR; therefore, it was not possible to answer the question posed. Instead, one has to apply a very simple rule: aim for the target beta-blocker dose used in clinical trials, and strive for the highest tolerated dose in all patients with heart failure, regardless of baseline and achieved HR.
Lars Gullestad; John Wikstrand; Prakash Deedwania; Ake Hjalmarson; Kenneth Egstrup; Uri Elkayam; Stephen Gottlieb; Andrew Rashkow; Hans Wedel; Georgina Bermann; John Kjekshus;
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  45     ISSN:  0735-1097     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2005 Jan 
Date Detail:
Created Date:  2005-01-17     Completed Date:  2005-02-22     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  252-9     Citation Subset:  AIM; IM    
Baerums Sykehus, Baerum, Norway.
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MeSH Terms
Adrenergic beta-Antagonists / therapeutic use*
Aged, 80 and over
Chronic Disease
Delayed-Action Preparations
Follow-Up Studies
Heart Failure / drug therapy*,  mortality,  physiopathology*
Heart Rate / physiology*
Metoprolol / analogs & derivatives*,  therapeutic use*
Middle Aged
Prospective Studies
Rest / physiology*
Risk Assessment
Treatment Outcome
Reg. No./Substance:
0/Adrenergic beta-Antagonists; 0/Delayed-Action Preparations; 0/metoprolol succinate; 37350-58-6/Metoprolol

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