Hemodynamic Differences Between Metoprolol and Carvedilol in Hypertensive Patients

Abstract

Resting hemodynamics were measured before, at 2 and 24 h after the first dose, and after 4 weeks of monotherapy with either metoprolol or carvedilol in a randomized single-blind study. We analyzed results from 24 hypertensive patients (30-68 years of age) with adequate blood-pressure lowering on monotherapy. Acutely, both drugs lowered systolic blood pressure and heart rate. Whereas metoprolol reduced cardiac output and increased both systemic and femoral artery resistance, carvedilol did not alter cardiac output but led to reductions in the systemic and regional resistances. After 4 weeks of therapy, cardiac output remained reduced and vascular resistances increased in the metoprolol group, whereas in carvedilol patients cardiac output continued to be unchanged and the trend for vascular resistances to be decreased persisted. Acutely and chronically the differences in the hemodynamic effects of the two medications were statistically significant. The study results indicate that carvedilol's vasodilatory action is not subject to tolerance development. Chronic afterload reduction associated with the decrease in systemic vascular resistance may lead to additional savings in myocardial oxygen consumption, a beneficial feature particularly in those patients with concomitant ischemic heart disease. It may also have a favorable influence on concentric cardiac hypertrophy and changes in the walls of arteriolar resistance vessels.

Inhibitory Effects of Carvedilol on Calcium Channels in Vascular Smooth Muscle Cells.

“…These results are compatible with the previous clinical findings showing that carvedilol decreases vascular resistance, while metoprolol does not. 25) It has been reported that carvedilol inhibits prostaglandin F 2α -induced contraction in VSM. 8,35) The present study also showed that carvedilol inhibits [Ca 2+ ] i rise through Ca 2+ entry elicited by vasopressin and endothelin-1.…”

Carvedilol: Molecular and Cellular Basis for Its Multifaceted Therapeutic Potential

“…The sympathetically mediated reflex tachycardia that usually accompanies peripheral vasodilation does not occur with carvedilol because of its nonselective cardiac â-adrenoceptor antagonist activity (86,90). In a randomized, single-blind study of 24 hypertensive patients, Weber et al (110) compared the resting hemodynamic effects of carvedilol (25 mg daily) and metoprolol (100 mg daily). Either drug lowered systolic blood pressure and heart rate by acute (2 h) or chronic (4 weeks) administration.…”

Tolerability of carvedilol and ACE‐Inhibition in mild heart failure. Results of CARMEN (Carvedilol ACE‐Inhibitor Remodelling Mild CHF EvaluatioN)

“…Whether these findings can be extended to other conventional, non‐vasodilating β‐blockers needs further investigation. Previous studies have confirmed that carvedilol, but not β−1 selective blockers, provides afterload reduction [10–12].…”