title: Second- and third-generation beta-blocking drugs in chronic heart failure.
abstract: The left-ventricular (LV) functional, hemodynamic, and antiadrenergic effects of metoprolol, bucindolol, and carvedilol have been compared in three concurrent placebo-controlled clinical trials in patients with symptomatic idiopathic dilated cardiomyopathy. All three drugs were well tolerated, all produced at least moderate degrees of beta-blockade as assessed by reduction in exercise heart rate, and all increased the left-ventricular ejection fraction. Compared with the beta 1-selective, second-generation compound metoprolol, the third-generation compounds bucindolol and carvedilol lowered indices of adrenergic activity and tended to improve LV function to a greater extent. In patients with chronic heart failure there may be important therapeutic response differences between second- and third-generation beta-blocking agents.
authors.affiliation: University of Colorado Health Sciences Center, Denver, USA.
authors.forename: M R
authors.initials: MR
authors.lastname: Bristow
authors.forename: W T
authors.initials: WT
authors.lastname: Abraham
authors.forename: T
authors.initials: T
authors.lastname: Yoshikawa
authors.forename: M
authors.initials: M
authors.lastname: White
authors.forename: B G
authors.initials: BG
authors.lastname: Hattler
authors.forename: T S
authors.initials: TS
authors.lastname: Crisman
authors.forename: B D
authors.initials: BD
authors.lastname: Lowes
authors.forename: A D
authors.initials: AD
authors.lastname: Robertson
authors.forename: P
authors.initials: P
authors.lastname: Larrabee
authors.forename: E M
authors.initials: EM
authors.lastname: Gilbert
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D002227:Carbazoles / Q000627:therapeutic use*; D002303:Cardiac Output, Low / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D002311:Cardiomyopathy, Dilated / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D000077261:Carvedilol; D002908:Chronic Disease; D005080:Exercise Test; D006352:Heart Ventricles / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008790:Metoprolol / Q000627:therapeutic use*; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications; D010101:Oxygen Consumption / Q000187:drug effects; D011412:Propanolamines / Q000627:therapeutic use*; D016277:Ventricular Function, Left / Q000187:drug effects
chemical_list: D000319:Adrenergic beta-Antagonists; D002227:Carbazoles; D011412:Propanolamines; D000077261:Carvedilol; C024307:bucindolol; D008790:Metoprolol