- Paper Report
- Open Access
Metoprolol vs carvedilol in heart failure
- Michael Norton1
© Biomed Central Ltd 2001
- Received: 4 October 2000
- Published: 17 October 2001
- ?-blockers, heart failure, medical therapy
This paper describes a randomised, double blind controlled trial comparing the haemodynamic and clinical effects of metoprolol and carvedilol in 150 patients with chronic heart failure.
This research was undertaken because there is very little evidence from data comparing ?-blockers in heart failure, although trials have shown that ?-blockers produce consistent benefits in patients with chronic heart failure. Metoprolol and bisoprolol selectively inhibit ?1 receptors but increase the density of b-receptors and tend to raise cardiac norepinephrine during long-term administration. Carvediol blocks a1, ?1 and ?2 receptors, decreases cardiac norepinephrine, suppresses ?-receptor density and appears to have additional anti oxidant and anti proliferative effects.
All patients had New York Heart Association class II, III or IV symptoms for at least 6 months and an ejection fraction of 35% or less by radionuclide ventriculography. Carvedilol also produced greater decreases in mean pulmonary artery and pulmonary wedge pressures (both at rest and during exercise). Metoprolol produced greater increases in maximal exercise capacity. The two drugs produced similar increases in symptoms, submaximal exercise tolerance and quality of life. During the 23 ? 11 month study period, 21 patients in the metoprolol group and 17 patients in the carvedilol underwent urgent transplantation.
A randomised double blind controlled trial
- Metra M, Giubbini R, Nodari S, Boldi E, Modena MG, Dei Cas LD: Differential effects of ?-blockers in patients with heart failure: A prospective, randomized, double-blind comparison of the long-term effects of metoprolol versus carvedilol. Circulation 2000, 102:546-551. Circulation. 2000, 102: 546-551.View ArticlePubMedGoogle Scholar