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Beta-blockade in heart failure: a comparison of carvedilol with metoprolol.
J Am Coll Cardiol. 1999 Nov 01; 34(5):1522-8.JACC

Abstract

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.

Authors+Show Affiliations

Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR. jesanderson@cuhk.edu.hkNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

10551702

Citation

Sanderson, J E., et al. "Beta-blockade in Heart Failure: a Comparison of Carvedilol With Metoprolol." Journal of the American College of Cardiology, vol. 34, no. 5, 1999, pp. 1522-8.
Sanderson JE, Chan SK, Yip G, et al. Beta-blockade in heart failure: a comparison of carvedilol with metoprolol. J Am Coll Cardiol. 1999;34(5):1522-8.
Sanderson, J. E., Chan, S. K., Yip, G., Yeung, L. Y., Chan, K. W., Raymond, K., & Woo, K. S. (1999). Beta-blockade in heart failure: a comparison of carvedilol with metoprolol. Journal of the American College of Cardiology, 34(5), 1522-8.
Sanderson JE, et al. Beta-blockade in Heart Failure: a Comparison of Carvedilol With Metoprolol. J Am Coll Cardiol. 1999 Nov 1;34(5):1522-8. PubMed PMID: 10551702.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Beta-blockade in heart failure: a comparison of carvedilol with metoprolol. AU - Sanderson,J E, AU - Chan,S K, AU - Yip,G, AU - Yeung,L Y, AU - Chan,K W, AU - Raymond,K, AU - Woo,K S, PY - 1999/11/7/pubmed PY - 1999/11/7/medline PY - 1999/11/7/entrez SP - 1522 EP - 8 JF - Journal of the American College of Cardiology JO - J Am Coll Cardiol VL - 34 IS - 5 N2 - 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. SN - 0735-1097 UR - https://www.unboundmedicine.com/medline/citation/10551702/Beta_blockade_in_heart_failure:_a_comparison_of_carvedilol_with_metoprolol_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0735-1097(99)00367-8 DB - PRIME DP - Unbound Medicine ER -