NEW YORK (Reuters Health) – The nonselective beta-blocker carvedilol and the beta-1-selective beta-blockers metoprolol succinate and bisoprolol have significantly different treatment effects in patients with chronic heart failure and chronic obstructive pulmonary disease (COPD), a new study shows.

“In terms of choice between the agents, more hemodynamically unstable patients may tolerate carvedilol better initially,” senior author Dr. Christopher S. Hayward from St. Vincent’s Hospital, Sydney, Australia told Reuters Health by email.

On the other hand, he continued, “Patients with a history of airways disease requiring inhaled therapies may tolerate bisoprolol or metoprolol better. Patient and physician preference then comes into play.”

Dr. Hayward and his colleagues assessed the respiratory, hemodynamic, and clinical effects of the three agents in 51 patients with stable heart failure on optimized therapy, including a beta blocking agent. Thirty-five of the subjects also had COPD.

The participants in the study received each beta blocker (dose-matched) for 6 weeks before resuming treatment with their original agent.

In the April 27th Journal of the American College of Cardiology, the authors report that forced expiratory volume in one second (FEV1) was significantly higher with bisoprolol or metoprolol than with carvedilol. There was no difference in FEV1 between bisoprolol and metoprolol, however.

Furthermore, central augmented pressure was reduced in patients taking carvedilol (by 2.3 mmHg compared with bisoprolol and by 1.6 mmHg compared with metoprolol).

“Notably,” however, levels of N-terminal pro-hormone brain natriuretic peptide (NT-proBNP) were reduced when patients switched to carvedilol, the authors report.

Six patients (12%) withdrew from the study due to dyspnea, angina, and (in one case) pancreatic cancer. Five of the six dropped out after switching from carvedilol to a beta-1-selective beta-blocker. Most participants reported mild lethargy and shortness of breath after switching drugs, but these symptoms generally subsided within a week.

“I would not advocate any of the beta-blockers in patients with significantly reversible airways disease (asthma) and perform formal respiratory lung function tests to check for bronchodilator reversibility if there is any concern,” Dr. Hayward said.

Reference:

J Am Coll Cardiol 2010;55:1780-1787.