Carvedilol versus Metoprolol in Patients with Ventricular Tachyarrhythmias

Abstract

The study investigates the prognostic role of treatment with carvedilol as compared to metoprolol in patients with ventricular tachyarrhythmias. A large retrospective registry was used including consecutive patients on beta-blocker (BB) treatment with episodes of ventricular tachycardia (VT) or fibrillation (VF) from 2002 to 2015. Patients treated with carvedilol were compared to patients with metoprolol. The primary prognostic outcome was all-cause mortality at three years. Secondary endpoints comprised a composite arrhythmic endpoint (i.e., recurrences of ventricular tachyarrhythmias, appropriate implantable cardioverter defibrillator (ICD) therapies) and cardiac rehospitalization. Kaplan–Meier survival curves, multivariable Cox regression analyses, and propensity score matching were applied for statistics. There were 1,098 patients included, 80% treated with metoprolol and 20% with carvedilol. Patients with carvedilol were older, more often presenting with VT (78% vs. 62%; p = 0.001) and with more advanced stages of heart failure. Treatment with carvedilol was associated with comparable all-cause mortality compared to metoprolol (20% vs. 16%, log rank p = 0.234; HR = 1.229; 95% CI 0.874–1.728; p = 0.235). However, secondary endpoints (i.e., composite arrhythmic endpoint: 32% vs. 17%; p = 0.001 and cardiac rehospitalization: 25% vs. 14%; p = 0.001) were more frequently observed in patients with carvedilol, which was still evident after multivariable adjustment. After propensity score matching (n = 194 patients with carvedilol and metoprolol), no further differences regarding the distribution of baseline characteristics were observed. Within the propensity-score-matched cohort, higher rates of the composite arrhythmic endpoint were still observed in patients treated with carvedilol, whereas the risk of cardiac rehospitalization was not affected by the type of beta-blocker treatment. In conclusion, carvedilol and metoprolol are associated with comparable all-cause mortality in patients with ventricular tachyarrhythmias, whereas the risk of the composite arrhythmic endpoint was increased in patients with carvedilol therapy.

Application of Several Nano Carriers to Improve the Solubility and the Bioavailability of Carvedilol

“…One of the third generations that are applicable in the markets with several concentrations is carvedilol (CAR) found in the market as monotherapy or in combination with other classes to control HBP, it is lipophilic, act on ß1-and ß2 receptors(non-selective blockers) also has additional advantages of block norepinephrine binding to α1 -adrenergic receptors, so control blood pressure by its mechanism 8 , it reduce tachycardia through inhibition of beta-adrenoreceptors, has an action on α1 -adrenergic receptors relaxes the smooth muscles in the vasculature, leading to reduced peripheral vascular resistance and an overall reduction in blood pressure 19 , 20 , indicated for the chronic therapy of heart failure with reduced ejection fraction (HFREF), reduction arterial BP, left ventricular dysfunction myocardial infarction (MI) in the clinically stable patient. On the other hand, CAR is completely absorbed from GIT.…”

A Review and Meta-Analysis of the Effect of Atenolol on All-Cause Mortality Risk among Asians With Chronic Progressive Diseases

“…In another study conducted among patients with the same chronic disease (ESRD), Wu et al revealed that bisoprolol was significantly associated with lower rates of all-cause mortality than carvedilol [5]. Among patients with ventricular tachyarrhythmia, Schupp et al found that the all-cause mortality rate was not significantly lower in metoprolol users compared to carvedilol [6]. With no significant difference, all-cause mortality rate among patients with advanced stages of heart failure was higher among nebivolol users than bisoprolol [7].…”