Carvedilol versus other beta-blockers in heart failure

Carvedilol is a P-blocker with ancillary. properties. Pilot clinical studie s with carvedilol, added to the standard therapy of digoxin, diuretics and ACE inhibitors, showed beneficial effects in mild. moderate and severe hear t failure. Patients consistently showed improvement in LV ejection fraction and NYHA functional class. Subsequently large clinical trials showed decre ased morbidity and mortality with carvedilol,l in mild and moderate and mor e recently, severe heart failure. However, there is little or no improvemen t in exercise tolerance with carvedilol. The beneficial effects of carvedil ol in heart failure are associated with cardiac remodelling. Metoprolol and bisoprolol are selective beta (1)-blockers without ancillary properties. E arly studies showed benefits with metoprolol and bisoprolol in heart failur e. Large clinical trials established that metoprolol and bisoprolol decreas ed mortality and morbidity; in heart failure. In contrast no benefit has be en shown with celiprolol. a selective beta (1)-blocker and beta (2)-stimula nt in heart failure. There is a debate as to whether the ancillary properti es of carvedilol contribute to its beneficial effect in heart failure, maki ng it a better drug to use than metoprolol. Short-term studies suggested th at carvedilol and metoprolol were equivalent in heart failure but short-ter m is probably not an appropriate way to compare the drugs. A recent long-te rm study and study in poor responders to metoprolol, suggest that carvedilo l may be better than metoprolol in heart failure.