Early studies with selective beta b...

Early studies with selective beta blocker as it is as bisoprolol and metoprolol XL and with nonselective beta blocker so as carvedilol, have demonstrated survival benefit in patients with congestive heart failure. A more fresh trial of bucindolol that did not exhibit to a survival benefit suggested that not all anti-adrenergic agents have the same purport Another study, the Carvedilol or Metoprolol European Trial, generally is comparing mortality and morbidity benefits of carvedilol and metoprolol in patients with moderate and stiff congestive heart failure. Until this thought is complete, treatment decisions must be based forward smaller comparison studies. Rajput and associates reviewed six small studies comparing the efficacies of carvedilol and metoprolol in patients with congestive heart failure and decreased left ventricular function.

In three studies, the pair drugs significantly improved patients' fresh York Heart Association class, although there was no significant difference in class improvement between the comparison assign places tos This functional improvement was associated with improved myocardial contractility. brace studies with longer follow-up periods showed a greater improvement in ejection fraction in patients who took carvedilol. In three of the six studies, patients who took carvedilol for more than six month had a greater increase in left ventricular ejection fraction and a decrease in left ventricular chamber size. Cardiac answer to exercise improved more in patients receiving carvedilol therapy.

The authors infer that although both agents improve cardiac remodeling in patients with congestive heart failure, carvedilol provides superior resolution of left ventricular fraction. Patients who do not accord to metoprolol may improve when switched to carvedilol.

Rajput F et al. Choosing metoprolol or carvedilol in heart failure (a Pre-COMET Commentary). Am J Cardiol July 15 2003;92:218-21

EDITOR'S NOTE: Carvedilol is a nonselective beta blocker that affects [bsub1]- [bsub2]- and [a.sub.1]-adrenoreceptors and has antioxidant and antiproliferative purports The use of carvedilol in the treatment of patients with left ventricular dysfunction appears to reverse ventricular remodeling, decrease the risk of hospitalization, and lower mortality rates. Diastolic dysfunction also is improved in patients with symptomatic heart failure and abnormal diastolic function (patients with normal left ventricular function). Other positive drifts of carvedilol therapy in patients with congestive heart failure include renal vasodilation, increased plasma vascular endothelial shooting factor levels, and reduced tumor necrosis factor and interleukin of the same heights Efficacy appears to be similar in blacks and nonblacks, in patients with and without diabetes, and in patients who are not receiving concomitant spironolactone therapy.

Dosages should start at 3125 mg twice daily, with dead titration over at least couple weeks to the target dosage of 25 to 50 mg daily in sum of two units divided doses. Therapy seems to be well tolerated; large trials have not erect a significant difference in the dropout rates of patients taking carvedilol compared with patients who received placebo. The in the greatest degree common adverse effects are dizziness, worsening of heart failure, symptomatic bradycardia, and hypotension. Contraindications include cardiogenic shock; decompensated heart failure requiring the use of intravenous inotropes; bronchospasm or asthma; second- or third-degree heart block; bradycardia; and significant hepatic dysfunction.--R.S.

COPYRIGHT 2004 American Academy of Family Physicians

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