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Effect of carvedilol rapid up-titration on malondialdehyde levels in patient with heart failure reduced ejection fraction

  • Abiseka Panji Baskoro ,
  • Habibie Arifianto ,
  • Trisulo Wasyanto ,
  • Heru Sulastomo ,
  • Ahmad Yasa ,
  • Niniek Purwaningtyas ,


Background: Malondialdehyde (MDA) is a marker that can assess the level of oxidative stress. Studies support that this marker can reflect the severity of heart failure. Carvedilol is a third-generation beta-blocker with antioxidant effects. Slow titration may contribute to the suboptimal dose use and therapeutic effect due to improved left ventricular systolic function and reduced dose-dependent mortality.

Aim: To determine the effect of rapid titration of carvedilol compared with standard titration according to standard guidelines on MDA levels in HFrEF (heart failure reduced ejection fraction) patients.

Methods: This study is a single-centre experimental study with a randomized, double-blind control trial conducted from October to December 2021. A total of 26 HFrEF patients undergoing treatment at UNS Hospital Sukoharjo were sequentially included in the study and then randomly divided into the rapid titration group carvedilol given an initial dose of 2 x 3.125 mg and increased every day with a target dose of 2 x 25 mg (or the maximum tolerated dose). The control group was given carvedilol dose titration according to standard guidelines. Blood plasma was taken on the first day before treatment and on the day the patient was discharged. MDA levels were checked by the ELISA method.

Results: The decrease in mean MDA levels was greater in the carvedilol rapid titration group than in the control group (2.84 ± 1.00 vs. 3.59 ± 2.55). However, these results were not statistically significant (p = 0.590). In the rapid titration group, carvedilol also showed a change in post-pre-MDA with a larger mean decrease (-0.55 ± 1.01) although not statistically significant (p = 0.157).

Conclusion: Rapid up-titration of carvedilol in patients with HFrEF during hospitalization can reduce MDA levels better than titration according to standard guidelines but is not statistically significant.


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How to Cite

Abiseka Panji Baskoro, Habibie Arifianto, Trisulo Wasyanto, Heru Sulastomo, Ahmad Yasa, & Niniek Purwaningtyas. (2022). Effect of carvedilol rapid up-titration on malondialdehyde levels in patient with heart failure reduced ejection fraction. Bali Medical Journal, 11(3), 2097–2102.




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