title: Differential effects of carvedilol and metoprolol on renal function in patients with heart failure.
abstract: BACKGROUND
  The aim of the present study was to verify the effects of beta-blockers on renal function in patients with heart failure (HF).
  
  
  RESULTS
  A total of 40 patients with HF (New York Heart Association class, II-III) were enrolled, who had beta-blocker therapy initiated with carvedilol (n=23) or metoprolol (n=17). The changes in renal and cardiac function were retrospectively analyzed over 16 weeks. The study population was divided into 2 groups according to the median baseline (65.9 ml/min) of estimated glomerular filtration rate (eGFR) calculated by the Modification of Diet in Renal Disease formula. eGFR significantly decreased in the higher eGFR group (P=0.04), but did not in the lower eGFR group. Left ventricular ejection fraction significantly increased in both groups with lower eGFR (P=0.01) and higher eGFR (P<0.01). There was an interaction between plasma norepinephrine concentration and eGFR in terms of beta-blocker treatment (P=0.02, ANOVA). eGFR significantly decreased in patients who received metoprolol (from 75.7+/-33.5 to 59.5+/-20.0 mlxmin(-1).1.73 m(-2), P<0.01), but did not change in those who received carvedilol (from 67.1+/-27.7 mlxmin(-1).1.73 m(-2) to 65.6+/-23.2 mlxmin(-1).1.73 m(-2)).
  
  
  CONCLUSIONS
  Beta-blockers preserved renal function in HF patients with lower baseline eGFR, but not in those with higher baseline eGFR. Carvedilol may be preferable to metoprolol to prevent the development of chronic kidney disease during beta-blocker therapy for HF.
authors.affiliation: Cardiology Division, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Ito
authors.forename: Yuji
authors.initials: Y
authors.lastname: Nagatomo
authors.forename: Takashi
authors.initials: T
authors.lastname: Kohno
authors.forename: Toshihisa
authors.initials: T
authors.lastname: Anzai
authors.forename: Tomomi
authors.initials: T
authors.lastname: Meguro
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ogawa
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Yoshikawa
mesh_terms: D058671:Adrenergic beta-1 Receptor Antagonists; D000368:Aged; D002227:Carbazoles / Q000494:pharmacology* / Q000627:therapeutic use; D000077261:Carvedilol; D004341:Drug Evaluation; D005260:Female; D005919:Glomerular Filtration Rate; D006333:Heart Failure / Q000150:complications*; D006801:Humans; D007668:Kidney / Q000187:drug effects* / Q000503:physiopathology; D007674:Kidney Diseases / Q000188:drug therapy / Q000517:prevention & control*; D007677:Kidney Function Tests; D008297:Male; D008790:Metoprolol / Q000494:pharmacology* / Q000627:therapeutic use; D008875:Middle Aged; D011412:Propanolamines / Q000494:pharmacology* / Q000627:therapeutic use; D012189:Retrospective Studies; D013318:Stroke Volume
chemical_list: D058671:Adrenergic beta-1 Receptor Antagonists; D002227:Carbazoles; D011412:Propanolamines; D000077261:Carvedilol; D008790:Metoprolol