Recently, large clinical trials have clearly shown that the third-generation β-blocker carvedilol reduces the risk of hospitalisation and death in patients with mild-to-moderate and severe heart failure.^1,2 The possibility that endothelial dysfunction per se contributes to the pathogenesis of heart failure has been postulated. It has also been reported that carvedilol stimulates nitric oxide (NO) release from endothelial cells.³ There is no information regarding the role of carvedilol in vascular function in patients with heart failure, but we hypothesised that treatment with carvedilol improves not only cardiac function but also endothelial function in patients with dilated cardiomyopathy (DCM).

METHODS

Sixteen male patients with stable DCM (mean age 53±17 years) who were admitted to Hiroshima University Hospital were enrolled in this study. The patients were divided randomly into a carvedilol group (carvedilol group; n = 8) and a conventional therapy group (control group; n = 8). Medical treatment consisted of administration of diuretics (n = 16), digitalis (n = 12), nitrate (n = 12), and angiotensin converting enzyme inhibitor (n = 9). Patients had received conventional therapy for 17±7 months (8–26 months) before enrolment in this study. The study protocol was approved by the ethics committees of Hiroshima University Graduate School of Biomedical Sciences and informed consent for participation was obtained from all subjects.

Carvedilol treatment was started after measurement of forearm blood flow (FBF) at a dose of 2.5 …