In heart failure, all beta-blockers are not necessarily equal.
The Carvedilol or Metoprolol European Trial (COMET; Lancet 2003; 362:7-13) found that in patients with heart failure, survival appears to be better with carvedilol than with immediate-release metoprolol tartrate. Whether the target doses used were equivalent (carvedilol 25 mg twice daily vs metoprolol tartrate 50 mg twice daily) has been debated, but the COMET trial shows that drugs in the same class do not necessarily have the same effects. Given the overwhelming evidence of the benefit of carvedilol, metoprolol succinate, and bisoprolol in patients with heart failure, we should all strive to increase the use of these drugs in appropriate doses.
Tang
W H Wilson
WH
The George M. and Linda H. Kaufman Center for Heart Failure, Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, OH 44195, USA. tangw@ccf.org
Militello
Michael
M
Francis
Gary S
GS
D000319:Adrenergic beta-Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D017298:Bisoprolol / Q000191:economics / Q000627:therapeutic use*; D002227:Carbazoles / Q000191:economics / Q000627:therapeutic use*; D000077261:Carvedilol; D002986:Clinical Trials as Topic; D003362:Cost-Benefit Analysis; D005260:Female; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008790:Metoprolol / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use*; D008875:Middle Aged; D011412:Propanolamines / Q000191:economics / Q000627:therapeutic use*
D000319:Adrenergic beta-Antagonists; D002227:Carbazoles; D011412:Propanolamines; D000077261:Carvedilol; D008790:Metoprolol; D017298:Bisoprolol