Influence of heart rate, blood pressure, and beta-blocker dose on outcome and the differences in outcome between carvedilol and metoprolol tartrate in patients with chronic heart failure: results from the COMET trial.

Abstract

AIMS:

We studied the influence of heart rate (HR), systolic blood pressure (SBP), and beta-blocker dose on outcome in the 2599 out of 3029 patients in Carvedilol Or Metoprolol European Trial (COMET) who were alive and on study drug at 4 months after randomization (time of first visit on maintenance therapy).

METHODS AND RESULTS:

By multivariable analysis, baseline HR, baseline SBP, and their change after 4 months were not independently related to subsequent outcome. In a multivariable analysis including clinical variables, HR above and SBP below the median value achieved at 4 months predicted subsequent increased mortality [relative risk (RR) for HR>68 b.p.m. 1.333; 95% confidence intervals (CI) 1.152-1.542; P<0.0001 and RR for SBP>120 mmHg 0.78; 95% CI 0.671-0.907; P<0.0013]. Achieving target beta-blocker dose was associated with a better outcome (RR 0.779; 95% CI 0.662-0.916; P<0.0025). The superiority of carvedilol as compared to metoprolol tartrate was maintained in a multivariable model (RR 0.767; 95% CI 0.663-0.887; P=0.0004) and there was no interaction with HR, SBP, or beta-blocker dose.

CONCLUSION:

Beta-blocker dose, HR, and SBP achieved during beta-blocker therapy have independent prognostic value in heart failure. None of these factors influenced the beneficial effects of carvedilol when compared with metoprolol tartrate at the pre-defined target doses used in COMET.

• Authors: Marco Metra, Christian Torp-Pedersen, Karl Swedberg, John G F Cleland, Andrea Di Lenarda, Michel Komajda, Willem J Remme, Beatrix Lutiger, Armin Scherhag, Mary Ann Lukas, Andrew Charlesworth, Philip A Poole-Wilson
• Journal: European heart journal (Eur Heart J) Vol. 26 Issue 21 Pg. 2259-68 (Nov 2005) ISSN: 0195-668X [Print] England
• PMID: 16040619 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Adrenergic beta-Antagonists
• Carbazoles
• Propanolamines
• Carvedilol
• Metoprolol

Topics

• Adrenergic beta-Antagonists (administration & dosage)
• Blood Pressure (physiology)
• Carbazoles (administration & dosage)
• Carvedilol
• Chronic Disease
• Dose-Response Relationship, Drug
• Double-Blind Method
• Female
• Heart Failure (drug therapy, mortality, physiopathology)
• Heart Rate (physiology)
• Humans
• Male
• Metoprolol (administration & dosage)
• Middle Aged
• Propanolamines (administration & dosage)
• Treatment Outcome