Differential effects of carvedilol and metoprolol succinate on plasma norepinephrine release and peak exercise heart rate in subjects with chronic heart failure

Timothy J. Vittorio, Ronald Zolty, Michael E. Kasper, Raj M. Khandwalla, David S. Hirsh, Chi Hong Tseng, Ulrich P. Jorde, Kartikya Ahuja

Research output: Contribution to journalArticle

14 Scopus citations

Abstract

Dosing equivalency of carvedilol and metoprolol remains a debate. Degree of β1-blockade is best assessed by blunting of the exercise-induced heart rate. Accordingly, the authors have investigated dosing equivalency by examining baseline and peak exercise heart rates and norepinephrine levels in subjects with chronic heart failure treated with carvedilol or metoprolol. Thirty-seven subjects treated with carvedilol (32.9 ± 3.5 mg; n = 23) or metoprolol succinate (XL) (96.4 ± 15.9 mg; n = 14) referred for cardiopulmonary exercise testing were studied prospectively. Carvedilol versus metoprolol XL subjects did not differ with respect to baseline heart rate (73 ± 2 vs 70 ± 3 bpm), or baseline plasma norepinephrine levels (597.5 ± 78.3 vs 602.1 ± 69.6 pg/mL), P = NS. However, despite similar peak exercise norepinephrine levels (2735.8 ± 320.1 vs 2403.1 ± 371.6 pg/mL), heart rate at peak exercise was higher in subjects receiving carvedilol (135 ± 4 bpm) than those receiving metoprolol XL (117 ± 6 bpm), P = 0.02. Similar norepinephrine release and more complete β1-blockade is observed in well-matched subjects with chronic heart failure treated with a mean daily dose of metoprolol XL 96.4 mg compared with carvedilol 32.9 mg.

Original languageEnglish (US)
Pages (from-to)51-57
Number of pages7
JournalJournal of Cardiovascular Pharmacology and Therapeutics
Volume13
Issue number1
DOIs
StatePublished - Mar 2008

Keywords

  • Carvedilol
  • Heart failure
  • Heart rate
  • Metoprolol
  • Neurohormonal
  • Norepinephrine

ASJC Scopus subject areas

  • Pharmacology
  • Cardiology and Cardiovascular Medicine
  • Pharmacology (medical)

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