J Card Fail. 2003 Dec;9(6):429-43.
Division of Circulatory Physiology, Columbia University College of
Physicians and Surgeons, New York, New York 10032, USA.
Experimental and clinical studies indicate that carvedilol exerts multiple
antiadrenergic effects in addition to beta(1)-receptor blockade, but the
prognostic importance of these actions has long been debated. This
controversy has now been substantially advanced by the results of the
recently completed Carvedilol Or Metoprolol European Trial (COMET), which
showed that carvedilol (25 mg twice daily) reduced mortality by 17% when
compared with metoprolol (50 mg twice daily), P=.0017--a result that was
consistent with the differences seen across earlier controlled trials with
beta-blockers in survivors of an acute myocardial infarction and in patients
with chronic heart failure. Questions have been raised about the
interpretation of these findings in view of the fact that the trial did not
use the dose or formulation of metoprolol that was shown to prolong life in
a placebo-controlled trial (ie, Metoprolol CR/XL [Controlled Release]
Randomized Intervention Trial in Heart Failure). Pharmacokinetic and
pharmacodynamic analyses, however, indicate that the dosing regimen of
metoprolol selected for use in the COMET trial produces a magnitude and time
course of beta(1)-blockade during a 24-hour period that is similar to the
dose of carvedilol targeted for use in the trial. These analyses suggest
that the observed difference in the mortality effects of metoprolol and
carvedilol is not related to a difference in the magnitude or time course of
their beta(1)-blocking effects but instead reflect antiadrenergic effects of
carvedilol in addition to beta(1)-blockade.
By Jill Stein
PARIS, FRANCE -- June 17, 2004 -- The
angiotensin II receptor blocker telmisartan produces significantly greater
left ventricular hypertrophy (LVH) regression than does the beta blocker
carvedilol in hypertensive patients, according to study findings.
Presenting data on June 14th at the 14th
meeting of the European Meeting on Hypertension, Domenico Galzerano, MD,
from San Gennaro Hospital in Naples, Italy, said that the findings suggest
that telmisartan provides an important mechanism beyond lowering blood
pressure in producing LVH regression in hypertensive patients. "The greater
LVH regression achieved with telmisartan may translate into improvements in
the risk reduction for cardiovascular events," he added.
Researchers recruited 82 patients with mild to
moderate hypertension and LVH to participate in the double-blind study. The
patients were randomised to treatment with either telmisartan 80 mg or
carvedilol 25 mg once daily for 44 weeks. No other antihypertensive
treatment was allowed for the duration of the study.
Both drugs were well tolerated. Ten patients
withdrew from the study because their diastolic blood pressure remained
greater than 90 mm Hg, and 2 patients withdrew because of dizziness.
Significant reductions in 24-hour mean systolic
and diastolic blood pressure were achieved with both telmisartan (P
<.001) and carvedilol (P
<.001) after treatment for 44 weeks.
The systolic blood pressure reduction achieved
with telmisartan was 30.9 ± 9.0 mm Hg versus 28.7 ± 9.1 mm Hg with
carvedilol. The difference between the 2 groups was not statistically
The diastolic blood pressure decrease with
telmisartan was 19.0 ±9.0 mm Hg, and the reduction achieved with carvedilol
was 17.1 ±5.0 mm Hg. The difference between the 2 groups was not
The results of 3-dimensional echocardiography
showed that both drugs significantly reduced LV mass index after 44 weeks of
In telmisartan-treated patients, LV mass index
was reduced by 21.9 ±5.9 g/m2, which represents a 15.7%
In carvedilol-treated patients, LV mass index
was reduced by 12.8 ±3.5 g/m2, representing a 9.0 % regression.
Telmisartan was significantly superior to carvedilol,
In addition, the use of magnetic resonance
imaging to assess LVH regression yielded similar results: a 15.0% regression
with telmisartan versus a 9.8% regression for carvedilol,
Overall, the results demonstrate that while
telmisartan and carvedilol provide comparable antihypertensive efficacy,
telmisartan is associated with significantly greater LVH regression, Dr.
Left ventricular hypertrophy is
a strong predictor of cardiovascular risk, especially in hypertensive
patients, and LVH regression is a key objective when managing hypertension.
The goal of this study
was to better characterize the young patient with aortic dissection(AoD).
dissection is unusual in young patients, and frequently associated with
collected on 951 patients diagnosed with AoD between January 1996 and
November 2001. Two categories of patients,
40 years and
40 years, were compared using
chi-square cross tabulations for categorical and Student
test for continuous data.
Sixty-eight patients (7%) with
40 years of age. Compared with
40 years, younger patients were less
likely to have a prior history of hypertension (p
however, younger patients were more likely to have Marfan syndrome, bicuspid
aortic valve, and prior aortic surgery (all, p
Clinical presentations in the two age groups were similar; however, younger
patients were less likely to be hypertensive (25% vs. 45%, p 0.003). The
proximal aortas of young AoD patients were larger (all, p
compared with older patients. These differences in aortic size between age
groups were not entirely related to Marfan syndrome. Mortality among young
patients was similar to patients
40 years of age
(22% vs. 24%, p NS), irrespective of the site of dissection.
older patients with AoD, young patients have unique risk factors for
dissection: Marfan syndrome, bicuspid aortic valves, and larger aortic
dimensions. Surprisingly, the mortality risk for young AoD patients is not
lower than older AoD patients.
(J Am Coll Cardiol