Pharmacological therapy for hypertrophic cardiomyopathy: what is the evidence for success?

Abstract

The available experience from studies of pharmacological treatment of patients with hypertrophic cardiomyopathy was mainly gained in selected patient samples, with severe symptoms or a complicated clinical setting. Moreover, most reports on drug efficacy are based on either acute mechanistic studies or non-controlled patient cohorts, which are usually rather restricted in numbers and followed for limited periods of time. Bearing in mind the symptomatic presentation of hypertrophic cardiomyopathy, which is sometimes highly variable and influenced to a degree by sympathetic arousal, it is understandable that a considerable placebo effect may occur when initiating any type of treatment. Considering the pathophysiology that underlies symptoms of hypertrophic cardiomyopathy, it is not surprising that the pharmacological agents that are most advocated are beta-blockers and calcium channel blockers ‐ drugs that impact on several of the factors that are responsible for the symptoms. Other compounds that may be used include antiarrhythmic drugs, of which disopyramide ‐ combining antiarrhythmic with negative inotropic properties ‐ has attracted particular interest. (Eur Heart J Supplements 2001; 3 (Suppl L): L21‐L25)