Rational Pharmacotherapy in Cardiology

Advanced search


Full Text:


Aim. To study effect of cardioselective β-adrenoblocker metoprolol tartrate (in retarded formulation) on quality of life in elderly patients with chronic heart failure (CHF) of ischemic etiology.

Material and methods. 78 patients with CHF class III (NYHA) were involved in the study. Patients were 81,6±0,25 y.o. in average. All patients had clinical signs of mild-to-moderate depressive disorders. Patients were split on 2 groups comparable in sex and age. Patients of the 1st group (n=43) received metoprolol tartrate (Egilok Retard), 50-100 mg/d additionally to standard therapy. Patients of the 2nd group (n=35) received only standard therapy. The somatic status was assessed before and after 1 and 3 months of therapy by clinical condition evaluated scale (CCES), 6-minute walking test, left ventricular ejection fraction (Echocardiography) as well as mental status by special tests (SMSP, BDI, Hamilton scale, C.D.Spilberger-Y.L.Hanin scale) and qualities of life (MLHFQ, SF-36).

Results. Reduction of CHF class from III to II was observed in 31 (76,7%) patients of the 1st group and in 23 (65,7%) patients of the 2nd group. Tolerability of Egilok Retard was good and there were not cessations because of side effects. In 3 months of therapy severity of the somatic status according to CCES reduced more significantly in the 1st group in comparison with the 2nd group (29,5 % vs 11,5 %, p <0,001). The exercise tolerance increased higher in the 1st group comparing with the 2nd one (34 % vs 17 %, respectively, p<0,001). The severity of depression reduced (according to SMSP, Hamilton scale) more significantly in the 1st group in comparison with this in the 2nd one. Quality of life also improved more significantly in the 1st group according to MLHFQ and SF-36 (physical functions, role physical functions, social function scales) at the end of therapy.

Conclusion. Metoprolol tartrate (in retarded formulation) improves somatic and mental status as well as quality of life in elderly patients with CHF.

About the Author

I. V. Vologdina
St.-Petersburg Medical Academy of Postgraduate Education
Russian Federation
Chair of Therapy and Clinical Pharmacology


1. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure). J Am Coll Cardiol 2005;46(6):e1-e82.

2. Wikstrand J., Warnold I, Tuomilehto J. et al. Metoprolol versus thiazide diuretics in hypertension. Morbidity results from the MAPHY study. Hypertension 1991;17:579-88.

3. Hjalmarson A, Elmfeldt D, Herlitz J. et al. Effects on mortality of metoprolol in acute myocardial infarction: a double-blind randomized trial. Lancet 1981;2:823-27.

4. Herlitz J, Waagstein F., Lindqvist J et al. Effect of metoprolol on the prognosis for patients with suspected acute myocardial infarction and indirect signs of congestive heart failure (subgroup analysis of the Goteborg Metoprolol Trial). Am J Cardiol 1997;80(9B): 40J-44J.

5. The MIAMI Trial Research group: Metoprolol in acute myocardial infarction (MIAMI): A randomized placebo-controlled international trial. Eur Heart J 1985;6:199-226.

6. Waagstein F, Bristow MR, Swedberg K: Beneficial effects of metoprolol in idiopathic dilated cardiomyopathy. Metoprolol in Dilated Cardiomyopathy (MDC) Trial Study Group. Lancet 1993;342:1441-46.

7. Смоленская О.Г., Жданова И.В., Семянникова Н.М., Силкина Н.Н. Эгилок в лечении хронической сердечной недостаточности у больных ИБС с нормальным и повышенным уровнем артериального давления. Росс кардиол журн 2002;4:48-52.

8. Нагайцева Е.Б., Вологдина И.В., Малыкина М.Д., Гончарова И.В. Применение метопролола тартрата у больных пожилого и старческого возраста при лечении ишемической болезни сердца, осложненной хронической сердечной недостаточностью. Росс кардиол журн 2003;3:45-9.

9. Стаценко М.Е., Старкова Г.В., Спорова О.Е., Беленкова С.В. Сравнительное исследование карведилола и метопролола тартрата у больных сердечной недостаточностью: особенности изменений кардиогемодинамики и функции почек. Фарматека 2006;(3):76- 9.

10. The MERIT-HF investigators. Effect of metoprolol in chronic heart failure: Metoprolol CR/XL Randomised intervention Trial in Congestive Heart Failure (MERIT-HF). Lancet 1999;353:2001-7.

11. Белоусов Ю.Б., Леонова М.В., Менешина А.В. и др. Метопролола сукцинат и тартрат: влияет ли соль на эффективность препарата? Фарматека 2006;(19):14-9

12. Беленков Ю.Н., Мареев В.Ю. Принципы рационального лечения сердечной недостаточности. М.: Медиа Медика; 2000.

13. Новик А.А., Ионова Т.И. Руководство по исследованию качества жизни в медицине. СПб.: Нева; 2002.

14. Национальные рекомендации по диагностике и лечению ХСН (Второй пересмотр). Журнал Сердечная недостаточность 2007;6(4):4- 42.

15. Терещенко С.Н. Как мы назначаем β-адреноблокаторы при ХСН? Журнал Сердечная недостаточность 2004;5(4):123.

16. Лопатин Ю.М. Симпато-адреналовая система при сердечной недостаточности: роль в патогенезе и возможности коррекции. Журнал Сердечная недостаточность 2003;4(2): 105-6.

17. Мартынов А.И. Метопролол: результаты контролируемых клинических исследований. Клиническая фармакология 2004;(3):48- 55.

18. Wilstrand J., Westergren G., Berglund G. et al. Antihypertensive treatment with metoprolol or hydrochlortiazide in patients aged 60 to 75 years. Report from a double-blind international multicenter study. JAMA 1986;255:1304-50.

19. LaPalio L., Schork A., Glasser S., Tift C Safety and efficacy of metoprolol in the treatment of hypertension in the elderly. J Am Geariatr Soc 1992;40:354-8.

20. Козиолова Н.А., Пермякова Ю.Н. Эффективность, безопасность и фармакоэкономический анализ лечения метопрололом больных хронической сердечной недостаточностью ишемической этиологии. Сердечная недостаточность 2002;3(4):183-5.

21. Kukin M.L., Manino M.M., Freudenberg R.S. et al. Hemodynamic comparison of twice daily metoprolol tartrate with once daily metoprolol succinate in congestive heart failure. J Am Coll Cardiol 2000;35:45- 50.

22. Sanderson J.E., Skiva K.W., Chan R.N. et al. Beta-blockade in heart failure. A comparison of carvedilol with metoprolol. J Am Coll Cardiol 1999;34:1522-8.

23. Poole-Wilson P.A., Swedberg K., Cleland J.G. et al. Comparison of carvedilol and metoprolol on clinical outcomes in patients with chronic heart failure in the Carvedilol Or Metoprolol Europen Trial (COMET): randomized controlled trial. Lancet 2003;362:7-14.

24. Dargie H. -blockers in heart failure. Lancet 2003;362:2-3.

25. Арутюнов Г.П. Проблемные вопросы исследования СОМЕТ. Журнал Сердечная недостаточность 2004;5(1):32-4.

26. Ko D.T., Coffey C.S., Sedrakyan A, Curtis J.P., Krumholz H.M. -blockers therapy and symptoms of depression, fatigue and sexual dysfunction. JAMA 2002;288(15):1845-6.

27. Jenkinson C., Jenkinson D., Shepperd S. et al. Evaluation of treatment for congestive heart failure in patients aged 60 years and older using generic measures of health status (SF-36 and COOP charts). Age Ageing 1997;26(1):7-13.

28. Дворецкий Л.И. Пожилой больной в практике терапевта. РМЖ 1997; 5(20): 1299-305.

For citation:


Views: 4313

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.

ISSN 1819-6446 (Print)
ISSN 2225-3653 (Online)