Clinical status and outcome of Japanese heart failure patients with reduced or preserved ejection fraction treated with carvedilol.

The effect of beta-blockers in treating Japanese heart failure (HF) patients with preserved left ventricular (LV) ejection fraction (EF) is unclear. This prospective observational study enrolled 1,682 Japanese HF patients who received carvedilol for the first time. Patients were followed for a mean of 1.6 years. The 1,492 patients with baseline LVEF measurements were allocated to the following groups: reduced EF (LVEF < 40%; n = 724), borderline EF (LVEF 4050%; n = 355), and preserved EF (LVEF ≥ 50%; n = 413). Baseline characteristics, New York Heart Association (NYHA) class, change in B-type natriuretic peptide (BNP) level, and long-term outcome were compared among the groups. Patients with preserved EF were more likely to be older, female, and have ischemic etiology and hypertension than patients with reduced EF. Carvedilol maintenance dosage was lower in patients with preserved EF (7.9 mg/day versus 6.6 mg/ day). NYHA class and BNP level were lower in patients with preserved EF at baseline but improved to the same level in all groups at 6 months. After adjusting for baseline characteristics, the hazard ratio for death or hospitalization due to cardiovascular disease in patients with preserved EF versus those with reduced EF was 1.031 (P = 0.847). This study elucidated the characteristics of HF patients given carvedilol in "real world" clinical settings. A comparative controlled study is necessary to elucidate whether the improvements in NYHA and BNP as well as the outcome profile observed in patients with preserved EF were caused by the favorable effects of carvedilol.

Influence of guidelines on physicians' assessment of blood pressure lowering effects and achievement rate of blood pressure target during transitional period of guidelines.

We studied the agreement rate between achievement of blood pressure (BP) target according to the 2002 Japanese Guidelines for Treatment of Hypertension in the Elderly (EG 2002) and the Japanese Society of Hypertension Guidelines 2004 (JSH 2004) versus a physicians' assessment of BP-lowering efficacy of olmesartan medoxomil in elderly patients. The physicians' assessment more closely agreed with the achievement rate of the BP target according to the EG 2002 than that according to the JSH 2004. This study was started in July 2004, shortly after JSH 2004 was published. Our data suggest that guidelines at the time strongly influence the physicians' assessment and their treatment strategy for individual patients in daily clinical practice.