Betaxolol is equivalent to carvedilol in patients with heart failure NYHA II or III: result of a randomized multicenter trial (BETACAR Trial).
BACKGROUND
In a recent COMET trial (Lancet 362, 2003:7-13) it could be demonstrated that carvedilol < or = 50 mg/d was superior to metoprolol tartrate < or = 100 mg/d in the treatment of heart failure patients NYHA II-IV.


OBJECTIVE
It was investigated whether the superiority of carvedilol with its beta1, beta2 and alpha-blocking potency will persist in a comparison to a highly selective beta1-blocker with a long plasma half-time such as betaxolol.


METHODS
255 pts. with NYHA II or III heart failure were double-blind randomized and uptitrated to either carvedilol 25 mg bid (n=131) or betaxolol 20 mg od (n=124).


RESULTS
Within 8 months left ventricular ejection fraction (LVEF) increased to the same extent from 30% to 43% (carvedilol) or 31% to 43% (betaxolol) as primary endpoint (ns). 13% of the carvedilol (CAR) patients versus 15% of the betaxolol patients (BET) suffered either from cardiac death or recurrent hospitalizations (cardiac death n=6 (CAR), n=2 (BET), ns). The mean increase in the 6-min walk test was 63 m with CAR and 61 m with BET and the Minnesota living with heart failure questionnaire improved in both groups (ns). Heart rate reduction was pronounced in both groups: CAR 13.1 beats/min, BET 13.6 beats/min.


CONCLUSIONS
The long acting highly selective beta1-blocker betaxolol in an adequate dosage is not inferior to carvedilol in terms of exercise tolerance, safety and effects on left ventricular function.
Figulla
Hans R
HR
Universitätsklinikum Jena, Germany. Hans.Figulla@med.uni-jena.de
Krzeminska-Pakula
Maria
M
Wrabec
Krzystof
K
Chochola
Jiri
J
Kalmbach
Claudia
C
Fridl
P
P
D000293:Adolescent; D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D015784:Betaxolol / Q000008:administration & dosage / Q000627:therapeutic use*; D002227:Carbazoles / Q000008:administration & dosage / Q000627:therapeutic use*; D000077261:Carvedilol; D004311:Double-Blind Method; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011412:Propanolamines / Q000008:administration & dosage / Q000627:therapeutic use*; D012189:Retrospective Studies; D013318:Stroke Volume / Q000187:drug effects / Q000502:physiology; D016896:Treatment Outcome
D000319:Adrenergic beta-Antagonists; D002227:Carbazoles; D011412:Propanolamines; D000077261:Carvedilol; D015784:Betaxolol