Department of Cardiology, Gentofte Hospital, Hellerup, Denmark.
Cardiovasc Diabetol. 2011 Oct 15;10:91. doi: 10.1186/1475-2840-10-91.
Carvedilol has been shown to be superior to metoprolol tartrate to improve clinical outcomes in patients with heart failure (HF), yet the mechanisms responsible for these differences remain unclear. We examined if there were differences in endothelial function, insulin stimulated endothelial function, 24 hour ambulatory blood pressure and heart rate during treatment with carvedilol, metoprolol tartrate and metoprolol succinate in patients with HF.
Twenty-seven patients with mild HF, all initially treated with carvedilol, were randomized to a two-month treatment with carvedilol, metoprolol tartrate or metoprolol succinate. Venous occlusion plethysmography, 24-hour blood pressure and heart rate measurements were done before and after a two-month treatment period.
Endothelium-dependent vasodilatation was not affected by changing from carvedilol to either metoprolol tartrate or metoprolol succinate. The relative forearm blood flow at the highest dose of serotonin was 2.42 ± 0.33 in the carvedilol group at baseline and 2.14 ± 0.24 after two months continuation of carvedilol (P = 0.34); 2.57 ± 0.33 before metoprolol tartrate treatment and 2.42 ± 0.55 after treatment (p = 0.74) and in the metoprolol succinate group 1.82 ± 0.29 and 2.10 ± 0.37 before and after treatment, respectively (p = 0.27). Diurnal blood pressures as well as heart rate were also unchanged by changing from carvedilol to metoprolol tartrate or metoprolol succinate.
Endothelial function remained unchanged when switching the beta blocker treatment from carvedilol to either metoprolol tartrate or metoprolol succinate in this study, where blood pressure and heart rate also remained unchanged in patients with mild HF.
Current Controlled Trials NCT00497003.
卡维地洛已被证明优于酒石酸美托洛尔，可改善心力衰竭（HF）患者的临床结局，但导致这些差异的机制仍不清楚。我们研究了在 HF 患者中使用卡维地洛、酒石酸美托洛尔和琥珀酸美托洛尔治疗时，内皮功能、胰岛素刺激的内皮功能、24 小时动态血压和心率是否存在差异。
27 例轻度 HF 患者，均初始接受卡维地洛治疗，随机分为卡维地洛、酒石酸美托洛尔或琥珀酸美托洛尔治疗 2 个月。在治疗前和治疗后 2 个月进行静脉闭塞容积描记法、24 小时血压和心率测量。
从卡维地洛转换为酒石酸美托洛尔或琥珀酸美托洛尔并不影响内皮依赖性血管舒张。在卡维地洛组，基线时最高剂量 5-羟色胺时的相对前臂血流量为 2.42±0.33，卡维地洛继续治疗 2 个月后为 2.14±0.24（P=0.34）；酒石酸美托洛尔治疗前为 2.57±0.33，治疗后为 2.42±0.55（p=0.74），琥珀酸美托洛尔组分别为 1.82±0.29 和 2.10±0.37 治疗前和治疗后（p=0.27）。昼夜血压和心率也不因从卡维地洛转换为酒石酸美托洛尔或琥珀酸美托洛尔而改变。
在本研究中，当从卡维地洛转换为酒石酸美托洛尔或琥珀酸美托洛尔时，β受体阻滞剂治疗的内皮功能保持不变，而轻度 HF 患者的血压和心率也保持不变。
当前对照试验 NCT00497003。
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