Comparison of carvedilol and metoprolol in heart failure management

Heart failure is one of the most prevalent diseases with high mortality and disability. Beta blockers are among basic drugs treating the disorder and leading to reduction in cardiovascular mortality, and improvement of symptoms and left ventricular function. Regarding the increasing prevalence of this disease, the present study was carried out to compare carvedilol with metoprolol in the treatment of patients with heart-failure. In this analytical and prospective study, which was carried out between March 2005 and June 2006, 73 patients with advanced heart failure (ejection fraction=EF= %30-35%) and functional class (FC) I to III were followed up for 6 months. 38 cases of the patients received metoprolol tartrate and 33 cases received carvedilol. Clinical data and left ventricular (LV) function indices before and after treatment as shown in echocardiography were recorded in a questionnaire. Then, these changes were compared statistically by means of SPSS (11.5). Mean age of the patients in the metprolol group was 576.6 and in the carvedilol was 56.87.3 years. Average daily dose of metoprolol and carvedilol was 75 mg and 25 mg respectively. Heart rate and blood pressure reduction due to respective treatments (NYHA class) Improvement was similar in two groups. Functional class of patients in both groups improved one degree (P<0.001). In metoprolol treated patients. Left Ventricular End Diastolic Diameter (LEDD) and Left Ventricular End Systolic Diameter (LVESD) reductions were 8.7mm and 2.3mm (P<0.001, P<0.001) as well as Left Ventricular End Diastolic Volume (LVEDV) and Left Ventricular End Systolic (LVES) reductions were 4.3 cc and 7.3 cc (P=0.008, P<0.001), respectively. Mean EF increased 3.3%. (P=0.000). In carvedilol treated patients LEDD and LESD reduced 2.78 mm (P<0.001) and 1.57 mm (P=0.045) and LVEDV & LVES reduced 2.3 cc (P=0.53) and 7.3 cc (P=0.007), respectively, and mean EF Increased 2.2% (P=0.004). There were no statistically significant differences between the two groups. In heart failure patients with FC I to III both metoprolol tartrate and carvedilol administration improves symptoms of the disease and LV function. In this study no significant differences were observed between the effects of the two drugs.