Are beta blockers equally effective in trating heart failure

Recently beta blockers have come under fire as hypertensive drugs
[ largely on the basis of the poor performance of atenolol] some 3rd
generation beta blockers show comparable results to ARBs and ace
inhibitors . but are older beta blockers less effective than newer
ones in the treatment of heart disease

Am Heart J. 2005 Feb;149(2):370-6. Links
Effects of metoprolol and carvedilol on cause-specific mortality and
morbidity in patients with chronic heart failure--COMET.Torp-Pedersen
C, Poole-Wilson PA, Swedberg K, Cleland JG, Di Lenarda A, Hanrath P,
Komajda M, Lutiger B, Metra M, Remme WJ, Scherhag A, Skene A; COMET
Investigators.
Department of Cardiology, Bispebjerg University Hospital, Copenhagen,
Denmark. ctp@xxxxxxxx

BACKGROUND: Beta-blockers with different receptor bindings reduce
mortality in patients with chronic heart failure. We compared the
effects of the beta1-blocker metoprolol tartrate and the beta1-,
beta2-, and alpha1-blocker carvedilol. METHODS: In a randomized double-
blind design, 3029 patients with chronic congestive heart failure
requiring diuretic therapy and with left ventricular dysfunction were
randomized to treatment with carvedilol (n = 1511) or metoprolol
tartrate (n = 1518) and titrated to target doses of 25 mg of
carvedilol twice daily or 50 mg of metoprolol tartrate twice daily.
The main outcome measures were total mortality and the combination of
mortality or hospitalization for any cause. Secondary end points were
cardiovascular death, combinations of morbidity and mortality, New
York Heart Association class, worsening of heart failure,
hospitalizations, and discontinuation of study therapy. RESULTS: A
total of 512 and 600 patients in the carvedilol group and metoprolol
group, respectively, died (hazard ratio [HR] 0.83, 95% CI 0.74-0.93, P
= .0017). Cardiovascular death was reduced by carvedilol (HR 0.80, 95%
CI 0.70-0.90, P = .0004). There were fewer sudden deaths and deaths
caused by circulatory failure or by stroke in the carvedilol group.
There was no difference in all-cause hospitalizations or in worsening
heart failure between treatment groups. The incidence of fatal or
nonfatal acute myocardial infarction was significantly lower in the
carvedilol group (HR 0.71, 95% CI 0.52-0.97, P = .03).
Discontinuations of study therapy were similar in the 2 groups.
CONCLUSION: Compared with metoprolol tartrate, carvedilol reduced
cardiovascular mortality, sudden death, death caused by circulatory
failure, death caused by stroke, as well as fatal and nonfatal
myocardial infarctions.

PMID: 15846279 [PubMed - indexed for MEDLINE]

Thanks Vince

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