brand logo

Am Fam Physician. 2004;69(4):958-961

Early studies with selective beta blockers, such as bisoprolol and metoprolol XL, and with nonselective beta blockers, such as carvedilol, have demonstrated survival benefit in patients with congestive heart failure. A more recent trial of bucindolol that did not show a survival benefit suggested that not all anti-adrenergic agents have the same effect. Another study, the Carvedilol or Metoprolol European Trial, currently is comparing mortality and morbidity benefits of carvedilol and metoprolol in patients with moderate and severe congestive heart failure. Until this study is complete, treatment decisions must be based on smaller comparison studies. Rajput and associates reviewed six small studies comparing the efficacies of carvedilol and metoprolol in patients with congestive heart failure and decreased left ventricular function.

In three studies, both drugs significantly improved patients' New York Heart Association class, although there was no significant difference in class improvement between the comparison groups. This functional improvement was associated with improved myocardial contractility. Two studies with longer follow-up periods showed a greater improvement in ejection fraction in patients who took carvedilol. In three of the six studies, patients who took carvedilol for more than six months had a greater increase in left ventricular ejection fraction and a decrease in left ventricular chamber size. Cardiac response to exercise improved more in patients receiving carvedilol therapy.

The authors conclude that although both agents improve cardiac remodeling in patients with congestive heart failure, carvedilol provides superior resolution of left ventricular fraction. Patients who do not respond to metoprolol may improve when switched to carvedilol.

Continue Reading

More in AFP

Copyright © 2004 by the American Academy of Family Physicians.

This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP.  See for copyright questions and/or permission requests.