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Controlled-release carvedilol in the management of systemic hypertension and myocardial dysfunction.

Frishman WH, Henderson LS, Lukas MA - Vasc Health Risk Manag (2008)

Bottom Line: However, vasodilatory beta-blockers such as carvedilol have a different hemodynamic action that provides the benefits of beta-blockade with the addition of vasodilation resulting from alpha 1-adrenergic receptor blockade.Vasodilation reduces total peripheral resistance, which may produce an overall positive effect on tolerability.Recently, a new, controlled-release carvedilol formulation has been developed that provides the clinical efficacy of carvedilol but is indicated for once-daily dosing.

View Article: PubMed Central - PubMed

Affiliation: Departments of Medicine and Pharmacology, New York Medical College/Westchester Medical Center, Valhalla, NY 10595, USA. william_frishman@nymc.edu

ABSTRACT
Cardiovascular disease is the leading cause of death worldwide. Within the treatment armamentarium, beta-blockers have demonstrated efficacy across the spectrum of cardiovascular disease--from modification of a risk factor (ie, hypertension) to treatment after an acute event (ie, myocardial infarction). Recently, the use of beta-blockers as a first-line therapy in hypertension has been called into question. Moreover, beta-blockers as a class are saddled with a misperception of having poor tolerability. However, vasodilatory beta-blockers such as carvedilol have a different hemodynamic action that provides the benefits of beta-blockade with the addition of vasodilation resulting from alpha 1-adrenergic receptor blockade. Vasodilation reduces total peripheral resistance, which may produce an overall positive effect on tolerability. Recently, a new, controlled-release carvedilol formulation has been developed that provides the clinical efficacy of carvedilol but is indicated for once-daily dosing. This review presents an overview of the clinical and pharmacologic carvedilol controlled-release data.

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Kaplan-Meier estimates of all-cause mortality in COMET. Reprinted from Poole-Wilson PA, Swedberg K, Cleland JG, et al Comparison of carvedilol and metoprolol on clinical outcomes in patients with chronic heart failure in the Carvedilol Or Metoprolol European Trial (COMET): randomised controlled trial. Lancet, 362:7–13. Copyright © 2003, with permission from Elsevier.
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f4-vhrm-4-1387: Kaplan-Meier estimates of all-cause mortality in COMET. Reprinted from Poole-Wilson PA, Swedberg K, Cleland JG, et al Comparison of carvedilol and metoprolol on clinical outcomes in patients with chronic heart failure in the Carvedilol Or Metoprolol European Trial (COMET): randomised controlled trial. Lancet, 362:7–13. Copyright © 2003, with permission from Elsevier.

Mentions: Additionally, over a mean duration of 58 months in the COMET study, significantly fewer deaths occurred in the carvedilol group (512 of 1511 patients; 34%) compared with the metoprolol group (600 of 1518 patients; 40%; p = 0.0017) (Figure 4) (Poole-Wilson et al 2003). Cardiovascular death was less prevalent in the carvedilol group than in the metoprolol group (438 versus 534 patients; p = 0.0004), as were sudden death, circulatory failure, and stroke (Poole-Wilson et al 2003; Torp-Pedersen et al 2005). Results for the combined endpoint of all-cause mortality or all-cause admissions were similar in both groups (74% and 76% of patients for carvedilol IR and metoprolol, respectively). It should be noted that metoprolol tartrate at 50 mg twice daily has not been shown in clinical trials to provide a mortality benefit. However, of note in the metoprolol succinate heart failure trial (MERIT-HF), the mean daily dose was 159 mg daily, which is equivalent to 106 mg daily of metoprolol tartrate (Poole-Wilson et al 2003).


Controlled-release carvedilol in the management of systemic hypertension and myocardial dysfunction.

Frishman WH, Henderson LS, Lukas MA - Vasc Health Risk Manag (2008)

Kaplan-Meier estimates of all-cause mortality in COMET. Reprinted from Poole-Wilson PA, Swedberg K, Cleland JG, et al Comparison of carvedilol and metoprolol on clinical outcomes in patients with chronic heart failure in the Carvedilol Or Metoprolol European Trial (COMET): randomised controlled trial. Lancet, 362:7–13. Copyright © 2003, with permission from Elsevier.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2663448&req=5

f4-vhrm-4-1387: Kaplan-Meier estimates of all-cause mortality in COMET. Reprinted from Poole-Wilson PA, Swedberg K, Cleland JG, et al Comparison of carvedilol and metoprolol on clinical outcomes in patients with chronic heart failure in the Carvedilol Or Metoprolol European Trial (COMET): randomised controlled trial. Lancet, 362:7–13. Copyright © 2003, with permission from Elsevier.
Mentions: Additionally, over a mean duration of 58 months in the COMET study, significantly fewer deaths occurred in the carvedilol group (512 of 1511 patients; 34%) compared with the metoprolol group (600 of 1518 patients; 40%; p = 0.0017) (Figure 4) (Poole-Wilson et al 2003). Cardiovascular death was less prevalent in the carvedilol group than in the metoprolol group (438 versus 534 patients; p = 0.0004), as were sudden death, circulatory failure, and stroke (Poole-Wilson et al 2003; Torp-Pedersen et al 2005). Results for the combined endpoint of all-cause mortality or all-cause admissions were similar in both groups (74% and 76% of patients for carvedilol IR and metoprolol, respectively). It should be noted that metoprolol tartrate at 50 mg twice daily has not been shown in clinical trials to provide a mortality benefit. However, of note in the metoprolol succinate heart failure trial (MERIT-HF), the mean daily dose was 159 mg daily, which is equivalent to 106 mg daily of metoprolol tartrate (Poole-Wilson et al 2003).

Bottom Line: However, vasodilatory beta-blockers such as carvedilol have a different hemodynamic action that provides the benefits of beta-blockade with the addition of vasodilation resulting from alpha 1-adrenergic receptor blockade.Vasodilation reduces total peripheral resistance, which may produce an overall positive effect on tolerability.Recently, a new, controlled-release carvedilol formulation has been developed that provides the clinical efficacy of carvedilol but is indicated for once-daily dosing.

View Article: PubMed Central - PubMed

Affiliation: Departments of Medicine and Pharmacology, New York Medical College/Westchester Medical Center, Valhalla, NY 10595, USA. william_frishman@nymc.edu

ABSTRACT
Cardiovascular disease is the leading cause of death worldwide. Within the treatment armamentarium, beta-blockers have demonstrated efficacy across the spectrum of cardiovascular disease--from modification of a risk factor (ie, hypertension) to treatment after an acute event (ie, myocardial infarction). Recently, the use of beta-blockers as a first-line therapy in hypertension has been called into question. Moreover, beta-blockers as a class are saddled with a misperception of having poor tolerability. However, vasodilatory beta-blockers such as carvedilol have a different hemodynamic action that provides the benefits of beta-blockade with the addition of vasodilation resulting from alpha 1-adrenergic receptor blockade. Vasodilation reduces total peripheral resistance, which may produce an overall positive effect on tolerability. Recently, a new, controlled-release carvedilol formulation has been developed that provides the clinical efficacy of carvedilol but is indicated for once-daily dosing. This review presents an overview of the clinical and pharmacologic carvedilol controlled-release data.

Show MeSH
Related in: MedlinePlus