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(Circulation. 1997;95:1764-1767.)
© 1997 American Heart Association, Inc.

Articles

Nonselective ß-Adrenergic Blockade With Carvedilol Does Not Hinder the Benefits of Exercise Training in Patients With Congestive Heart Failure

Laura Demopoulos, MD; Michael Yeh, MD; Marco Gentilucci, MD; Marco Testa, MD; Rachel Bijou, MD; Stuart D. Katz, MD; Donna Mancini, MD; Margaret Jones, RN; Thierry H. LeJemtel, MD

From the Department of Medicine (L.D., M.Y., M.G., R.B., M.J., T.H.L.), Division of Cardiology, The Albert Einstein College of Medicine, Bronx, NY; Ospedale Casa Sollievo della Sofferenza (M.T.), San Giovanni, Rotundo, Italy; and Division of Circulatory Physiology (S.D.K., D.M.), Columbia Presbyterian Hospital, New York, NY.

Correspondence to Thierry H. LeJemtel, MD, Albert Einstein College of Medicine, 1300 Morris Park Ave, Forchheimer G-42, Bronx, NY 10461.

Background Long-term ß-adrenergic blockade does not appear to be associated with drug-induced training in patients with congestive heart failure (CHF); whether exercise training can increase peak aerobic capacity in patients with CHF who are treated with ß-adrenergic blockers is currently unknown.

Methods and Results We studied 23 patients with CHF who were treated with carvedilol or propranolol in addition to ACE inhibitors, furosemide, and digoxin. Of the patients treated with carvedilol, 8 underwent exercise training and 8 remained sedentary. All 7 patients treated with propranolol underwent exercise training. Peak oxygen consumption (mL·kg^-1·min^-1) was serially measured in trained and sedentary patients. Peak reactive hyperemia (mL·min^-1·100 mL^-1) was determined in the calf and forearm immediately before and after 12 weeks of training. The peak oxygen consumption of trained patients treated with either carvedilol or propranolol increased from 12.9±1.4 to 16.0±1.6 (P<.001) and 12.4±1.0 to 15.7±0.9 (P<.001) mL·kg^-1·min^-1, respectively, whereas it did not change in the sedentary patients. Peak reactive hyperemia increased significantly in the calves but not the forearms of trained patients.

Conclusions Long-term, nonselective ß-adrenergic blockade with carvedilol or propranolol does not prevent patients with CHF from deriving systemic and regional benefits from physical training.

Key Words: carvedilol • receptors, adrenergic, beta • heart failure • exercise • regional blood flow • vasculature

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