Metoprolol and atenolol in mild-to-moderate chronic heart failure: The comparison of survival benefit

Abstract

The clinical end-point of all causes of mortality and cardiovascular hospitalisation (combined end-points) is a widely accepted indicator of heart failure survival. The primary aim of this study was to examine the effects of metoprolol and atenolol on combined end-points in patients with mild-to-moderate heart failure. This study was designed to be comparative, prospective, and random. The criteria for study inclusion were: age of 70 years or less, New York Heart Association (NYHA) Functional Class II and III, and an ejection fraction of the left ventricle of 40% or less. The patients (a total of 150) on therapy with angiotensin-converting enzyme inhibitor and a diuretic were randomised into three numerically equal therapy groups: 1) an atenolol group; 2) a metoprolol group; and 3) a control group (without beta-blockers). The follow-up period was 12 months. The results were analysed using: the hi-square test, variance analyses, Kaplan-Meier's model, Wilcox's statistics, and Cox's model. The cumulative survival rate for patients treated with metoprolol was 88%, 78% for patients treated with atenolol, and 48% for patients from the control group. It is clear that the cumulative survival rate for patients treated with metoprolol and atenolol is significantly higher compared to patients from the control group. In addition, the survival rate of patients treated with metoprolol was considerably higher compared to the survival rate of patients treated with atenolol. Metoprolol has significantly reduced the relative risk of combined end-points (71%) compared to atenolol (53%). The results of this comparative study clearly indicate that metoprolol and atenolol have a favourable effect on the survival rate of patients with chronic heart failure. In addition, metoprolol is considerably more effective than atenolol.

Beta-blockers in Cardiovascular Therapy: A Review

“…The trial was interrupted early because bisoprolol demonstrated a significant reduction in mortality, compared to placebo. This trial confirmed that in patients with heart failure, betablockers improve the left-ventricular function (20).…”

“…This study investigated the role of carvedilol in patients with systolic heart failure for a period of 10 months and observed that the use of carvedilol is associated with a relief of heart failure symptoms and decreased hospitalizations. The mortality rate in this study was reduced by 35% for patients treated with carvedilol (20).…”

“…Randomized trials that investigated the effects of beta-blockers in heart failure demonstrated that these agents are associated with a decreased risk of mortality and hospitalizations (20).…”

Systolic blood pressure, heart rate, and outcomes in patients with coronary disease and heart failure

“…21 While atenolol has not been extensively studied for a mortality benefit in patients with HF, two small randomized trials have shown that atenolol, as compared with placebo, is associated with a survival benefit in patients with chronic HF. 22,23 In the present study, the addition of HCTZ may have offset any mortality benefit of atenolol, if any, in the beta-blocker group. Notably, the concern for possible lack of benefit from atenolol in HF patients is partly related to only once-daily dosing, 22 whereas in INVEST, atenolol was given twice daily.…”

“…Another much larger study showed no effect of the combination on mortality . While atenolol has not been extensively studied for a mortality benefit in patients with HF, two small randomized trials have shown that atenolol, as compared with placebo, is associated with a survival benefit in patients with chronic HF . In the present study, the addition of HCTZ may have offset any mortality benefit of atenolol, if any, in the beta‐blocker group.…”