Carvedilol (
Dilatrend) blocks beta(1)-, beta(2)- and alpha(1)-adrenoceptors, and has
antioxidant and antiproliferative effects.
Carvedilol improved left ventricular ejection fraction (LVEF) in patients with chronic
heart failure (CHF) in numerous studies. Moreover, significantly greater increases from baseline in LVEF were seen with
carvedilol than with
metoprolol in a double-blind, randomised study and in a meta-analysis.
Carvedilol also reversed or attenuated left ventricular remodelling in patients with CHF and in those with
left ventricular dysfunction after acute
myocardial infarction (MI). Combined analysis of studies in the US
Carvedilol Heart Failure Trials Program (patients had varying severities of CHF; n = 1094) revealed that mortality was significantly lower in
carvedilol than in placebo recipients. In addition, the risk of hospitalisation for any cardiovascular cause was significantly lower with
carvedilol than with placebo. Mortality was significantly lower with
carvedilol than with
metoprolol in patients with mild to severe CHF in the
Carvedilol Or
Metoprolol European Trial (COMET) [n = 3029]. The
Carvedilol Prospective Randomised Cumulative Survival (COPERNICUS) trial (n = 2289) demonstrated that compared with placebo,
carvedilol was associated with significant reductions in all-cause mortality and the combined endpoint of death or hospitalisation for any reason in severe CHF. All-cause mortality was reduced in patients who received
carvedilol in addition to conventional
therapy compared with those who received placebo plus conventional
therapy in the
Carvedilol Post-
Infarct Survival Control in
LV Dysfunction (CAPRICORN) trial (enrolling 1959 patients with
left ventricular dysfunction following acute MI).
Carvedilol was generally well tolerated in patients with CHF. Adverse events associated with the alpha- and beta-blocking effects of the
drug occurred more commonly with
carvedilol than with placebo, whereas placebo recipients were more likely to experience worsening
heart failure. In conclusion,
carvedilol blocks beta(1)-, beta(2)- and alpha(1)-adrenoceptors and has a unique pharmacological profile. It is thought that additional properties of
carvedilol (e.g.
antioxidant and antiproliferative effects) contribute to its beneficial effects in CHF.
Carvedilol improves ventricular function and reduces mortality and morbidity in patients with mild to severe CHF, and should be considered a standard treatment option in this setting. Administering
carvedilol in addition to conventional
therapy reduces mortality and attenuates myocardial remodelling in patients with
left ventricular dysfunction following acute MI. Moreover, mortality was significantly lower with
carvedilol than with
metoprolol in patients with mild to severe CHF, suggesting that
carvedilol may be the preferred beta-blocker.