Results of clinical trials with diuretics in heart failure

The Cold War in pharmacology: a bibliometric analysis of Berlin's contributions to Naunyn‑Schmiedeberg's Archives of Pharmacology (1947-1974)

After World War II, Berlin was divided into the West, controlled by The United States, the UK, and France, and the East, controlled by the Soviet Union, resulting in a Cold War for decades. This bibliometric study analyzes the influence of the Cold War on pharmacological research in Berlin by evaluating publication patterns in Naunyn-Schmiedeberg's Archives of Pharmacology from 1947 to 1974 (n = 383). The publications highlight the political disparities in scientific output, exacerbated by the founding of the Free University of Berlin (FUB) as a countermeasure to Soviet repression, promoting academic freedom in West-Berlin. Researchers in West-Berlin published many more papers in Naunyn-Schmiedeberg's Archives of Pharmacology than researchers in East-Berlin and received much more citations. West-Berlin adopted English as a scientific language much more rapidly than East-Berlin. West-Berlin and East-Berlin focused on totally different research topics. This paper demonstrates how political freedom, financial support, and internationalization boosted research productivity in West-Berlin. In contrast, political suppression, financial scarcity, and restricted international ties hindered scientific development in East-Berlin.

Comparative effects of carvedilol vs bisoprolol for severe congestive heart failure

BACKGROUND

Although carvedilol and bisoprolol are effective medicines for the treatment of patients with heart failure (HF), only a few reports have compared their effects. This study was designed to compare the effects of them in patients with severe HF.

METHODS AND RESULTS

A total of 655 consecutive patients with HF, categorized as New York Heart Association Class 3 or 4, were retrospectively investigated. Of these patients, 217 were administered beta-blockers after admission and were divided into 2 groups (carvedilol, n=110; bisoprolol, n=107). No significant differences were observed in their characteristics between the 2 groups prior to the introduction of the beta-blockers. After 18 months of follow-up, there were no significant differences in the survival and cardiac event-free rates between the 2 groups. In contrast, there were several significant differences in patients with atrial fibrillation (AF) (carvedilol, n=40; bisoprolol, n=43). The percent changes in heart rate and brain natriuretic peptide level improved significantly in the bisoprolol group than in the carvedilol group. Furthermore, more patients in the bisoprolol group were defibrillated from AF to sinus rhythm than those in the carvedilol group (48% vs 16%; P=0.03).

CONCLUSIONS

Our data suggest that the 2 beta-blockers are equally effective in the improvement of severe HF, but bisoprolol shows favorable effects in patients with AF.

[A new look at adult chronic heart failure in Africa in the age of the Doppler echocardiography: experience of the medicine department at Yaounde General Hospital]

OBJECTIVE

Heart failure is a frequent and severe condition in Africa, yet few African data are available that take into account modern advances like echocardiography in diagnosis. This study aimed to characterize the epidemiological, clinical, etiologic and therapeutic features of heart failure at Yaounde General Hospital.

METHODS

A descriptive study was carried from October 1998 to November 2001. One hundred and sixty-seven patients presenting with clinical and echocardiographic signs of heart failure were included, among which 99 men and 68 women, mean aged 57 years.

RESULTS

Heart failure was the reason for 5,77% of all hospital admissions. Rehospitalisation rate was 8,33%, the prevalence 30% and overall mortality was 9,03%. 44% of patients were in class III of the NYHA and 7% in class IV. Dyspnoea was a constant symptom (95,20%); hepatomegaly was the most frequent physical finding (41,92%). Cardiac cavities were dilated and left ventricular ejection fraction was low in patients with systolic (70%) and combined (20%) dysfunction. Isolated diastolic heart failure accounted for 10% of cases. Main aetiologies were: Hypertension (54,49%), cardiomyopathies (26,34%) and valvular heart diseases (24,55%). Ischaemic heart disease was the fifth aetiology (2,39%). Medical treatment consisted of loop diuretics (90%), angiotensin-converting enzyme inhibitor (64,7%), digoxin (30,5%) and beta blockers (19,8%).

CONCLUSIONS

The clinical syndrome of heart failure constitutes a major public health problem in Cameroon. Echocardiography is of paramount importance in confirming the diagnosis and precising its aetiology. Preventive and public health strategies need to be defined according to the local characteristics.

Inotropic activity of hydroindene amidinohydrazones

Several hydroindenic derivatives (7a-methyl-2,3,5,6,7,7a-hexahydro-1H-indenes), bearing an amidinohydrazone at C-5 and different moieties at C-1, have been synthesized and evaluated for their inotropic and chronotropic effects on right- and left-guinea-pig-atria activity. Three of them showed the same profile as digoxin, although with lower potency. The effect on Na(+),K(+)-ATPase (NKA) was also evaluated for these three compounds, observing that two of them, with the same absolute configuration as natural cardenolides, are also NKA inhibitors, while the compound with the opposite configuration lacks such an effect. More interestingly, both active compounds act without affecting the cardiac rhythm. This could be related to the selective inhibition of the human alpha2beta1 isozyme (associated with the inotropic effect) with respect to the alpha1beta1 isozyme (associated with the maintenance of basal ionic levels in the cell and the toxic effect of cardenolides).

Angiotensin converting enzyme (ACE) inhibitors in the treatment of heart failure in general practice in north Cumbria

BACKGROUND

A great deal of research has demonstrated the benefits of treating patients with chronic heart failure with Angiotensin Converting Enzyme (ACE) inhibitors. There is rather less research on the actual uptake of treatment in general practice, and in particular methods that might improve that uptake.

AIM

To study the attitudes and practice of medical practitioners in North Cumbria in the treatment of heart failure.

METHOD

Semi-structured interviews with 16 general practitioners and nine hospital physicians in the Carlisle area and an audit of general practice case notes.

RESULTS

Two hundred and fifty-eight patients were identified with heart failure. Prevalence was 1.1%. Fifty percent were on an ACE inhibitor, the mean dose of which was less than half the typical research dose. Patients who had an echocardiogram were much more likely to be on an ACE inhibitor. General practitioners were enthusiastic to use ACE inhibitors, but felt that greater access to echocardiography was required. Hospital physicians were happy to improve access within an agreed protocol.

CONCLUSION

Improved uptake of ACE inhibitors could be assisted by the development of a protocol for investigation and treatment. This protocol should be evidence-based and agreed between local GPs, hospital physicians and the Health Authority.

Effects of short-acting and long-acting loop diuretics on heart rate variability in patients with chronic compensated congestive heart failure

BACKGROUND

We investigated the effects of a short-acting loop diuretic (furosemide) and a long-acting loop diuretic (azosemide) on heart rate variability, fluid balance, and neurohormonal responses in patients with mild to moderate chronic congestive heart failure.

METHODS

Nineteen patients with mild to moderate chronic congestive heart failure received furosemide (40 to 60 mg/day) or azosemide (60 to 90 mg/day) for 5 days in a crossover manner. We performed time-domain and frequency-domain analyses of 24-hour Holter electrocardiographic recordings to assess heart rate variability.

RESULTS

The 24-hour urinary sodium excretion was similar during the furosemide and azosemide treatment periods but was significantly greater in the first 2 hours after drug administration during furosemide treatment. Plasma renin activity and the hematocrit level increased and high-frequency power significantly decreased 2 hours after the administration of furosemide only. The standard deviation of all normal R-R intervals and the root mean square of successive differences in the R-R interval were lower with furosemide than with azosemide (P <.05).

CONCLUSIONS

Furosemide, a short-acting loop diuretic, has a greater influence on heart rate variability and fluid balance than azosemide, a long-acting loop diuretic, in patients with mild to moderate chronic congestive heart failure.

Heart failure treatments: issues of safety versus issues of quality of life

Congestive heart failure is an important cause of morbidity and mortality in western countries. The profound impact that congestive heart failure has on life expectancy and quality of life has been a continuous stimulus for the development of new drugs for the treatment of this condition. Despite favourable effects on (aspects of) quality of life in short term studies, several of these new agents have been shown to reduce survival in mortality trials. However, patients with severe congestive heart failure may experience such incapacitating symptoms that the question should be raised as to whether an improvement in quality of life makes the increased risk of mortality associated with these new agents acceptable. Drugs which improve quality of life at the expense of an increased risk of mortality can be of value in the treatment of patients with severe congestive heart failure. However, this is only the case if the probability of improvement in quality of life and prolongation of life expectancy for those using the drug exceeds the probability of improvement in quality of life and prolongation of life expectancy for those not using the drug. Unfortunately, most clinical trials in which both mortality and quality of life are evaluated fail to provide information on this composite probability. Despite disappointing results of some recent mortality trials on new pharmacological treatments of congestive heart failure, sound and well designed clinical trials on innovative heart failure treatments in which these composite probabilities are also assessed should be carried out.