RECENT OBSERVATIONS WITH BETA-ADRENOCEPTOR BLOCKADE - BENEFICIAL-EFFECTS IN HYPERTENSION AND HEART-FAILURE

Carvedilol is a third-generation vasodilating beta-blocker initially a pproved for the treatment of hypertension. It lowers systemic arterial blood pressure without causing reflex tachycardia and preserves renal function, More recently, carvedilol has been shown to reduce morbidit y and mortality in patients with congestive heart failure. This reduct ion may occur in part via beta-blockade and alpha(1)-adrenoceptor bloc kade, the latter resulting in vasodilation. Importantly, carvedilol an d several of its metabolites are potent antioxidants that may inhibit the oxidation of norepinephrine and the subsequent formation of toxic intermediates, such as reactive free radicals in the myocardium. As a result, carvedilol inhibits the expression of certain genes involved i n myocardial damage, such as intracellular adhesion molecule-1, free-r adical-induced activation of transcription factors, and programmed cel l death or apoptosis. In this respect, carvedilol represents a new the rapy for the treatment of hypertension and congestive heart failure an d combines, ire one molecule, a number of potentially beneficial prope rties. (C) 1998 American Journal of Hypertension, Ltd.