Second- and third-generation beta-blocking drugs in chronic heart failure.
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.
Bristow
M R
MR
University of Colorado Health Sciences Center, Denver, USA.
Abraham
W T
WT
Yoshikawa
T
T
White
M
M
Hattler
B G
BG
Crisman
T S
TS
Lowes
B D
BD
Robertson
A D
AD
Larrabee
P
P
Gilbert
E M
EM
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
D000319:Adrenergic beta-Antagonists; D002227:Carbazoles; D011412:Propanolamines; D000077261:Carvedilol; C024307:bucindolol; D008790:Metoprolol