BACKGROUND: In a recent COMET trial (Lancet 362, 2003:7-13) it could be demonstrated that carvedilol < or = 50 mg/d was superior to metoprolol tartrate < or = 100 mg/d in the treatment of heart failure patients NYHA II-IV. OBJECTIVES: It was investigated whether the superiority of carvedilol with its beta1, beta2 and alpha-blocking potency will persist in a comparison to a highly selective beta1-blocker with a long plasma half-time such as betaxolol. METHODS: 255 pts. with NYHA II or III heart failure were double-blind randomized and uptitrated to either carvedilol 25 mg bid (n=131) or betaxolol 20 mg od (n=124). RESULTS: Within 8 months left ventricular ejection fraction (LVEF) increased to the same extent from 30% to 43% (carvedilol) or 31% to 43% (betaxolol) as primary endpoint (ns). 13% of the carvedilol (CAR) patients versus 15% of the betaxolol patients (BET) suffered either from cardiac death or recurrent hospitalizations (cardiac death n=6 (CAR), n=2 (BET), ns). The mean increase in the 6-min walk test was 63 m with CAR and 61 m with BET and the Minnesota living with heart failure questionnaire improved in both groups (ns). Heart rate reduction was pronounced in both groups: CAR 13.1 beats/min, BET 13.6 beats/min. CONCLUSIONS: The long acting highly selective beta1-blocker betaxolol in an adequate dosage is not inferior to carvedilol in terms of exercise tolerance, safety and effects on left ventricular function.
RCT Entities:
BACKGROUND: In a recent COMET trial (Lancet 362, 2003:7-13) it could be demonstrated that carvedilol < or = 50 mg/d was superior to metoprolol tartrate < or = 100 mg/d in the treatment of heart failurepatients NYHA II-IV. OBJECTIVES: It was investigated whether the superiority of carvedilol with its beta1, beta2 and alpha-blocking potency will persist in a comparison to a highly selective beta1-blocker with a long plasma half-time such as betaxolol. METHODS: 255 pts. with NYHA II or III heart failure were double-blind randomized and uptitrated to either carvedilol 25 mg bid (n=131) or betaxolol 20 mg od (n=124). RESULTS: Within 8 months left ventricular ejection fraction (LVEF) increased to the same extent from 30% to 43% (carvedilol) or 31% to 43% (betaxolol) as primary endpoint (ns). 13% of the carvedilol (CAR) patients versus 15% of the betaxololpatients (BET) suffered either from cardiac death or recurrent hospitalizations (cardiac death n=6 (CAR), n=2 (BET), ns). The mean increase in the 6-min walk test was 63 m with CAR and 61 m with BET and the Minnesota living with heart failure questionnaire improved in both groups (ns). Heart rate reduction was pronounced in both groups: CAR 13.1 beats/min, BET 13.6 beats/min. CONCLUSIONS: The long acting highly selective beta1-blocker betaxolol in an adequate dosage is not inferior to carvedilol in terms of exercise tolerance, safety and effects on left ventricular function.
Authors: Meaghan Lunney; Marinella Ruospo; Patrizia Natale; Robert R Quinn; Paul E Ronksley; Ioannis Konstantinidis; Suetonia C Palmer; Marcello Tonelli; Giovanni Fm Strippoli; Pietro Ravani Journal: Cochrane Database Syst Rev Date: 2020-02-27
Authors: Patrick Lugenbiel; Alexander Bauer; Kamilla Kelemen; Patrick A Schweizer; Rüdiger Becker; Hugo A Katus; Dierk Thomas Journal: J Am Heart Assoc Date: 2012-04-24 Impact factor: 5.501