Kohno Takashi, Yoshikawa Tsutomu, Yoshizawa Akihiro, Nakamura Iwao, Anzai Toshihisa, Satoh Toru, Ogawa Satoshi
Cardiology Division, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.
Cardiovasc Drugs Ther. 2005 Oct;19(5):347-55. doi: 10.1007/s10557-005-4761-9.
It is still uncertain whether or not there is a difference between metoprolol and carvedilol for the treatment of congestive heart failure. We attempted to determine the difference between the two beta-blockers in terms of their antiadrenergic effect during exercise in patients with heart failure and their efficacy based on the baseline plasma brain natriuretic peptide concentration.
Fifty-three patients with mild to moderate heart failure with a radionuclide left ventricular ejection fraction <40% received open label metoprolol or carvedilol in a randomized fashion. The increase in the heart rate normalized to the increase in the plasma norepinephrine concentration during exercise, was calculated as an index of adrenergic responsiveness during exercise.
The increase in heart rate normalized by the increase in plasma norepinephrine concentration, decreased after the initiation of beta-blockers in the carvedilol group, but not in the metoprolol group. The change in cardiac function was more favorable for carvedilol than metoprolol in patients who exhibited a higher baseline brain natriuretic peptide concentration.
Carvedilol exerts a more potent antiadrenergic effect than metoprolol during stress in patients with mild to moderate heart failure. Carvedilol appears to be more efficacious than metoprolol in patients who exhibit higher baseline brain natriuretic peptide concentrations. These differences should be kept in mind when selecting appropriate pharmacologic agents in the treatment of heart failure.
美托洛尔和卡维地洛在治疗充血性心力衰竭方面是否存在差异仍不确定。我们试图确定这两种β受体阻滞剂在心力衰竭患者运动期间的抗肾上腺素能作用以及基于基线血浆脑钠肽浓度的疗效方面的差异。
53例轻度至中度心力衰竭且放射性核素左心室射血分数<40%的患者以随机方式接受开放标签的美托洛尔或卡维地洛治疗。计算运动期间心率增加与血浆去甲肾上腺素浓度增加的比值，作为运动期间肾上腺素能反应性的指标。
卡维地洛组开始使用β受体阻滞剂后，心率增加与血浆去甲肾上腺素浓度增加的比值降低，而美托洛尔组未降低。在基线脑钠肽浓度较高的患者中，卡维地洛对心功能的改善比美托洛尔更有利。
在轻度至中度心力衰竭患者应激期间，卡维地洛比美托洛尔具有更强的抗肾上腺素能作用。在基线脑钠肽浓度较高的患者中，卡维地洛似乎比美托洛尔更有效。在选择治疗心力衰竭的合适药物时应牢记这些差异。
