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Carvedilol
Could the author comment on the use of carvedilol?
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Carvedilol is a unique drug that combines the properties of a nonspecific  -blocker and a specific  1–blocker in a ratio of 2:3.1-2 It also possesses antioxidant properties. The drug has been shown to be effective, well tolerated, and safe when used immediately in patients with acute myocardial infarction, including those with heart failure.3 In a placebo-controlled trial, carvedilol was given within 24 hours from the onset of severe chest pain, initially intravenously at 2.5 mg over 15 minutes and then orally at 6.25 mg twice daily, and gradually increased to 12.5 mg twice daily and 25 mg twice daily for up to 6 months after myocardial infarction. It caused significant reductions in heart rate, blood pressure at rest, rate-pressure product at peak exercise, and increased left ventricular compliance (P<.001). It also attenuated left ventricular remodeling. There was also a 45% reduction in death or reinfarction compared with placebo. The beneficial effects of carvedilol have been attributed to its hemodynamic and antioxidant properties. Carvedilol has been shown to be quite effective in reducing the risk of death and hospitalization from cardiovascular causes in patients with congestive heart failure.4
With respect to the effects of carvedilol on left ventricular hypertrophy, several studies have shown that it significantly reduces left ventricular mass and myocardial fibrosis in both humans5 and animals.6 In stroke-prone, spontaneously hypertensive rats exposed to a high-salt diet, carvedilol completely reversed the hypertension, reduced ventricular and septal cardiac mass, and restored left ventricular remodeling. These effects are expected from a drug that reduces blood pressure and left ventricular afterload through vasodilation and blockade of the sympathetic tone.
Steven G. Crysant, MD
Oklahoma City, Okla
1. Chrysant SG. Fixed low-dose drug combination for the treatment of hypertension. Arch Fam Med. 1998;7:370-376.
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2. Fishman WH. Drug therapy: carvedilol. N Engl J Med. 1998;339:1759-1765.
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3. Basu S, Senior R, Raval U, Vanderdoes R, Bruckner T, Lahiri A. Beneficial effects of intravenous and oral carvedilol treatment in acute myocardial infarction: a placebo-controlled, randomized trial. Circulation. 1997;96:183-191.
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4. Packer M, Bristow MR, Cohn JN, et al. The effect of carvedilol on morbidity and mortality in patients with chronic heart failure. N Engl J Med. 1996;334:1349-1355.
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5. Hansson L, Himmelmann A. Carvedilol in the treatment of hypertension: a review of the clinical database. Scand Cardiovasc J Suppl. 1998;47:67-80.
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6. Barone FC, Campbell WG Jr, Nelson AH, Veverstein GZ. Carvedilol prevents severe hypertensive cardiomyopathy and remodeling. J Hypertens. 1998;16:871-884.
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ISI
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Arch Fam Med. 1999;8:295.
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