CLINICAL STUDIES
Beta-blockade in heart failure
A comparison of carvedilol with metoprolol
John E. Sanderson, MD, FACC*,
Skiva K. W. Chan, RN*,
Gabriel Yip, MRCP*,
Leata Y. C. Yeung, RN, BSc*,
Kam W. Chan, FRCR ,
Kenneth Raymond, PhD and
Kam S. Woo, MD, FACC*
* Departments of Medicine and Therapeutics, Diagnostic Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
Department of Organ Imaging, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
Department of Pharmacy, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
Manuscript received January 5, 1999;
revised manuscript received May 12, 1999,
accepted June 28, 1999.
Reprint requests and correspondence: Dr. J.E. Sanderson, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, 9/F Clinical Sciences Building, Prince of Wales Hospital, Shatin, N.T., Hong Kong SAR, China.
jesanderson{at}cuhk.edu.hk
OBJECTIVES
This study was performed to compare the long-term clinical efficacy of treatment with metoprolol versus carvedilol in patients with chronic heart failure.
BACKGROUND
Beta-adrenergic blockade is of proven value in chronic heart failure. Metoprolol, a selective beta-blocker, is widely used, but recent trials suggest carvedilol, a nonselective beta-blocker with alpha-1-receptor antagonist activity and antioxidant activities, is also effective. It is uncertain, however, if these additional properties of carvedilol provide further clinical benefit compared with metoprolol.
METHODS
In this randomized double-blind control trial, 51 patients with chronic heart failure and mean left ventricular (LV) ejection fraction of 26% ± 1.8% were randomly assigned treatment with metoprolol 50 mg twice daily or carvedilol 25 mg twice daily in addition to standard therapy after a four-week dose titration period for a total of 12 weeks. Response was assessed by a quality of life questionnaire, New York Heart Association class, exercise capacity (6-min walk test), radionucleotide ventriculography for LV ejection fraction, two-dimensional echocardiography measurement of LV dimensions and diastolic filling and 24-h electrocardiograph monitoring to assess heart rate variability.
RESULTS
Both carvedilol and metoprolol produced highly significant improvement in symptoms (p < 0.001), exercise capacity (p < 0.05) and LV ejection fraction (p < 0.001), and there were no significant differences between the two drugs. Carvedilol had a significantly greater effect on sitting and standing blood pressure, LV end-diastolic dimension and normalized the mitral E wave deceleration time.
CONCLUSIONS
Both metoprolol and carvedilol were equally effective in improving symptoms, quality of life, exercise capacity and LV ejection fraction, although carvedilol lowers blood pressure more than metoprolol.
|
Abbreviations and Acronyms
| | ECG | = electrocardiograph | | LV | = left ventricular |
|
This article has been cited by other articles:
|
|
|
|
 
G W K Yip, M Wang, T Wang, S Chan, J W H Fung, L Yeung, T Yip, S-T Lau, C-P Lau, M-O Tang, et al.
The Hong Kong diastolic heart failure study: a randomised controlled trial of diuretics, irbesartan and ramipril on quality of life, exercise capacity, left ventricular global and regional function in heart failure with a normal ejection fraction
Heart,
May 1, 2008;
94(5):
573 - 580.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. A. Woodcock, X.-J. Du, M. E. Reichelt, and R. M. Graham
Cardiac {alpha}1-adrenergic drive in pathological remodelling
Cardiovasc Res,
February 1, 2008;
77(3):
452 - 462.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. Brixius, R. Lu, B. Boelck, S. Grafweg, F. Hoyer, C. Pott, U. Mehlhorn, W. Bloch, and R. H. G. Schwinger
Chronic Treatment with Carvedilol Improves Ca2+-Dependent ATP Consumption in Triton X-Skinned Fiber Preparations of Human Myocardium
J. Pharmacol. Exp. Ther.,
July 1, 2007;
322(1):
222 - 227.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
W. J. Remme, C. Torp-Pedersen, J. G.F. Cleland, P. A. Poole-Wilson, M. Metra, M. Komajda, K. Swedberg, A. Di Lenarda, P. Spark, A. Scherhag, et al.
Carvedilol Protects Better Against Vascular Events Than Metoprolol in Heart Failure: Results From COMET
J. Am. Coll. Cardiol.,
March 6, 2007;
49(9):
963 - 971.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. M. Ecker, C.-C. Lin, J. Powers, B. K. Kobilka, A. M. Dubin, and D. Bernstein
Effect of targeted deletions of {beta}1- and {beta}2-adrenergic-receptor subtypes on heart rate variability
Am J Physiol Heart Circ Physiol,
January 1, 2006;
290(1):
H192 - H199.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. G. Olsson, K. Swedberg, A. L. Clark, K. K. Witte, and J. G.F. Cleland
Six minute corridor walk test as an outcome measure for the assessment of treatment in randomized, blinded intervention trials of chronic heart failure: a systematic review
Eur. Heart J.,
April 2, 2005;
26(8):
778 - 793.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Momen, D. Bower, J. Boehmer, A. R. Kunselman, U. A. Leuenberger, and L. I. Sinoway
Renal blood flow in heart failure patients during exercise
Am J Physiol Heart Circ Physiol,
December 1, 2004;
287(6):
H2834 - H2839.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Satwani, G. W. Dec, and J. Narula
{beta}-Adrenergic Blockers in Heart Failure: Review of Mechanisms of Action and Clinical Outcomes
Journal of Cardiovascular Pharmacology and Therapeutics,
October 1, 2004;
9(4):
243 - 255.
[Abstract]
[PDF]
|
|
|
|
|
|
|
N G Bellenger, K Rajappan, S L Rahman, A Lahiri, U Raval, J Webster, G D Murray, A J S Coats, J G F Cleland, and D J Pennell
Effects of carvedilol on left ventricular remodelling in chronic stable heart failure: a cardiovascular magnetic resonance study
Heart,
July 1, 2004;
90(7):
760 - 764.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. L. Bauman and R. L. Talbert
Pharmacodynamics of{beta}-Blockers in Heart Failure: Lessons from the Carvedilol Or Metoprolol European Trial
Journal of Cardiovascular Pharmacology and Therapeutics,
April 1, 2004;
9(2):
117 - 128.
[Abstract]
[PDF]
|
|
|
|
|
|
|
T. Toyama, H. Hoshizaki, R. Seki, N. Isobe, H. Adachi, S. Naito, S. Oshima, and K. Taniguchi
Efficacy of Carvedilol Treatment on Cardiac Function and Cardiac Sympathetic Nerve Activity in Patients with Dilated Cardiomyopathy: Comparison with Metoprolol Therapy
J. Nucl. Med.,
October 1, 2003;
44(10):
1604 - 1611.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J E Sanderson and T-f Tse
Heart failure: a global disease requiring a global response
Heart,
June 1, 2003;
89(6):
585 - 586.
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. Stoschitzky
Beta-blockers in chronic heart failure
Eur. Heart J.,
March 1, 2002;
23(5):
426 - 426.
[Full Text]
[PDF]
|
|
|
|
|
|
|
W. Remme and K. Swedberg
A reply
Eur. Heart J.,
March 1, 2002;
23(5):
426 - 427.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. H. Farrell, J. M. Foody, and H. M. Krumholz
{beta}-Blockers in Heart Failure: Clinical Applications
JAMA,
February 20, 2002;
287(7):
890 - 897.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Mak and G. E. Newton
The Oxidative Stress Hypothesis of Congestive Heart Failure : Radical Thoughts
Chest,
December 1, 2001;
120(6):
2035 - 2046.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. R. Azevedo, T. Kubo, S. Mak, A. Al-Hesayen, A. Schofield, R. Allan, S. Kelly, G. E. Newton, J. S. Floras, and J. D. Parker
Nonselective Versus Selective {beta}-Adrenergic Receptor Blockade in Congestive Heart Failure: Differential Effects on Sympathetic Activity
Circulation,
October 30, 2001;
104(18):
2194 - 2199.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. Maack, T. Elter, G. Nickenig, K. LaRosee, M. Crivaro, A. Stablein, H. Wuttke, and M. Bohm
Prospective crossover comparison of carvedilol and metoprolol in patients with chronic heart failure
J. Am. Coll. Cardiol.,
October 1, 2001;
38(4):
939 - 946.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. Ohtsuka, M. Hamada, G. Hiasa, O. Sasaki, M. Suzuki, Y. Hara, Y. Shigematsu, and K. Hiwada
Effect of beta-blockers on circulating levels of inflammatory and anti-inflammatory cytokines in patients with dilated cardiomyopathy
J. Am. Coll. Cardiol.,
February 1, 2001;
37(2):
412 - 417.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. G. F. Cleland, M. L. Kukin, J. Kalman, R. H. Charney, D. K. Levy, C. Buchholz-Varley, O. N. Ocampo, and C. Eng
Are All {beta}-Blockers for Heart Failure the Same? Response
Circulation,
August 8, 2000;
102
(6):
e41 - e42.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Metra, R. Giubbini, S. Nodari, E. Boldi, M. G. Modena, and L. D. Cas
Differential Effects of {beta}-Blockers in Patients With Heart Failure : A Prospective, Randomized, Double-Blind Comparison of the Long-Term Effects of Metoprolol Versus Carvedilol
Circulation,
August 1, 2000;
102(5):
546 - 551.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Wei, L. T. C. Chow, and J. E. Sanderson
Effect of carvedilol in comparison with metoprolol on myocardial collagen postinfarction
J. Am. Coll. Cardiol.,
July 1, 2000;
36(1):
276 - 281.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
