Use Of Toprol-XL Improved Survival In CHF Trial

	June 11, 1999 - Adding Toprol-XL, a beta-blocker,
to standard treatment in CHF patients reduced the
overall death rate by 34%, according to results of the
Metoprolol CR/XL Randomized Intervention Trial in Heart
Failure (MERIT-HF). The MERIT-HF study also found a 41%
reduction in sudden deaths among patients treated with
Toprol-XL. Results of MERIT-HF are published in the
current issue of The Lancet.
	The MERIT-HF Study is the first beta-blocker
trial to include patients across a wide spectrum of heart
failure severity. The study found that adding Toprol-XL
gave benefit regardless of how severe the disease was,
with similar responses for patients in heart classes 2,
3 and 4.
	In MERIT-HF, almost 4,000 patients in 14
countries with moderate-to-severe heart failure were
given either once-daily doses of placebo or Toprol-XL,
titrating from 12.5mg or 25mg to 200mg per day over 6
weeks. The study's main aim was to the drug to placebo
for total mortality in CHF patients. Other outcomes
such as hospitalisations, quality of life and economics
were also measured. Full analysis of this data is 
underway.
	MERIT-HF was stopped early on October 31, 1998,
due to the significant reduction in death in those 
patients on Toprol-XL.
	Metoprolol CR/XL (marketed in the USA as 
Toprol-XL) is prescribed for high blood pressure and
angina. It is currently not prescribed for CHF. As with
most beta-blockers, it should not be given to people with
sinus bradycardia, heart block greater than first degree,
cardiogenic shock or acute heart failure. Patients with
ischemic heart disease should not suddenly stop taking
a beta-blocker.
	Stephen Gottlieb, MD, associate professor of
medicine at University of Maryland School of Medicine
and on the MERIT-HF committee says, "We are encouraged
by the 34% reduction in all-cause mortality, which adds
to the growing body of evidence of the benefits of using
beta-blockers in heart failure."