Kveiborg Britt, Major-Petersen Atheline, Christiansen Buris, Torp-Pedersen Christian
Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark.
Vasc Health Risk Manag. 2007;3(1):31-7.
Beta-blockers have been shown to improve survival in patients with chronic heart failure. The effect of different generations of beta blockers has been debated. Both metoprolol and carvedilol have demonstrated beneficial effects in placebo-controlled trials. In The Carvedilol Or Metoprolol European Trial (COMET) two beta blockers were compared in a double-blind randomized matter. This is the first direct comparison between metoprolol and carvedilol of long-term effect on survival in patients with chronic heart failure. The all-cause mortality was significantly reduced in the favour of carvedilol. The dose and formulation of metoprolol used in this trial has caused debate, and it has been questioned whether a similar beta1-blockade is obtained in the two intervention groups. At this time there is an unresolved debate as to whether carvedilol is a superior beta-blocker or whether differences in beta1-blockade explained the results of COMET.
β受体阻滞剂已被证明可提高慢性心力衰竭患者的生存率。不同代β受体阻滞剂的效果一直存在争议。美托洛尔和卡维地洛在安慰剂对照试验中均显示出有益效果。在卡维地洛或美托洛尔欧洲试验（COMET）中，两种β受体阻滞剂在双盲随机试验中进行了比较。这是美托洛尔和卡维地洛对慢性心力衰竭患者生存率长期影响的首次直接比较。全因死亡率显著降低，有利于卡维地洛。该试验中使用的美托洛尔剂量和剂型引发了争议，有人质疑两个干预组是否获得了相似的β1受体阻滞效果。目前，关于卡维地洛是否是更优的β受体阻滞剂，或者β1受体阻滞的差异是否解释了COMET的结果，仍存在未解决的争议。
