Comparison of the hemodynamic effects of metoprolol and carvedilol in hypertensive patients

Abstract

Metoprolol and carvedilol are widely used in the treatment of hypertension, but no randomized comparison of their hemodynamic activity has been previously reported. Their comparative effects on heart rate, systemic blood pressure, and echocardiographically determined aortic and femoral artery blood flow were measured at rest and at 2 and 24 hours after the first dose of each drug, and again after 4 weeks of sustained monotherapy in 12 male and 12 female patients, aged 36-68 years with uncomplicated sustained hypertension according to a randomized single-blind protocol. Nine patients in each drug group achieved the target diastolic blood pressure of < 90 mmHg on the initial doses of each drug; this was achieved in the remainder following doubling of each dose. Neither drug occasioned withdrawal of any patient due to adverse reactions. Both drugs significantly reduced heart rate, although the reduction at 2 hours was significantly greater after metoprolol than after carvedilol. Both drugs reduced systolic pressure throughout the study; the reduction at 2 hours was significantly greater after carvedilol than after metoprolol. In contrast, the diastolic blood pressure was persistently reduced only by carvedilol. The cardiac output, determined as the aortic systolic blood flow, after carvedilol was not significantly different from pretreatment values throughout the study but was significantly reduced in the metoprolol-treated patients at each point of measurement. After metoprolol the systemic and femoral vascular resistances derived from conventional formulae were consistently and significantly increased over pretreatment values throughout the study and were significantly greater than in the carvedilol group at all measurement points. The hemodynamic differences between these two beta-blocking drugs may be explained by the additional vasodilator activity of carvedilol associated with its alpha 1-adrenoceptor blocking activity. The long-term clinical and prognostic implications of these pharmacodynamic differences between beta-adrenoceptor antagonists with and without additional vasodilator activity in the treatment of hypertensive patients remain to be determined.

Carvedilol in the Treatment of Hypertension - A Review of the Clinical Data Base

“…In a doubleblind comparison with propranolol in patients with essential hypertension, carvedilol did not reduce forearm blood flow, in contrast to propranolol (50). In a short-term randomized hemodynamic comparison between carvedilol and metoprolol it was confirmed that CO did not change with carvedilol even after 4 weeks of treatment whereas a significant reduction was seen in the metoprolol-treated patients (51).…”

Treatment of diabetic hypertension

“…Beta‐blockers lead to peripheral vasoconstriction that results in erectile dysfunction, decreased renal blood flow and increased peripheral resistance that limits the antihypertensive effect of beta‐blockers. However, peripheral vasoconstriction also decreases the microvascular surface area within the skeletal muscle that results in a decreased surface area for insulin‐mediated entry of glucose into muscle and increased insulin resistance [46,47].…”

Estimation of Clinical and Pharmacokinetic Equivalence of Original and Generic Carvedilols in Patients With Hypertension of 1-2 Grades

“…В отличие от β 1 -селективных блокаторов карведилол блокирует также β 2 -и α-адренорецепторы. Блокада α-адренорецепторов приводит к периферической вазодилатации и тем самым к уменьшению периферического сопротивления, что играет роль в снижении артериального давления (АД) [4,5]. Типичное для БАБ неблагоприятное влияние на обмен глюкозы и липидов также уменьшается за счет дополнительного αадреноблокирующего эффекта [6,7].…”