Beta-blockers are an indispensable element of drug therapy in heart failure (HF). Several multicenter trials have confirmed the beneficial effects of some of them on the survival, hospitalizations, morbidity, and the various clinical aspects of this disease.
The treatment with beta-blockers reduces hospitalizations (total and cardiovascular in HF), improves the functional class and leads to delayed worsening of HF. This benefit has been consistently observed in subgroups of different age, sex, functional class, left ventricular ejection fraction (LVEF), ischemic or non-ischemic etiology (Grade of recommendation I, level of evidence A).
In patients with LV systolic dysfunction, with or without symptomatic heart failure after acute MI, long-term treatment with beta-blockers in addition to ACE inhibition is recommended, in order to reduce mortality (degree of recommendation I, level of evidence B) .
In patients with HF there may be differences in the clinical effect of the different beta-blockers. Four beta-blockers are mainly recommended for the treatment of HF, depending on the case – bisoprolol, carvedilol, metoprolol succinate or nebivolol (degree of recommendation I, level of evidence A).
What are the differences of carvedilol in comparison with the other three?
In addition to beta-1, carvedilol blocks beta 2 and alpha 1-adrenoceptors and has antioxidant properties. Sarvedilol improves the left ventricular ejection fraction in patients with chronic heart failure (CHF).
Moreover, in cases of CHF and left ventricular dysfunction after myocardial infarction (MI), the treatment with carvedilol limits the remodelling of the left ventricle.
The study COPERNICUS- Carvedilol Prospective Randomized Cumulative Survival Study (with 2289 participants) demonstrated that carvedilol significantly reduced mortality and hospitalizations for severe (grade III-IV in NYHA) CHF. Another study – CAPRICORN -Carvedilol Post-Infarction Survival Control in Left Ventricular Dysfunction (1959 patients with LV systolic dysfunction after-MI) demonstrated the beneficial effects of carvedilol in infarction condition – that it reduced mortality.
The particular importance of the antioxidant properties of carvedilol are as follows:
– Reduction of the oxidative stress on cardiomyocytes – a delay of the remodelling of the ventricular wall;
– Reduction of the importance of the “reperfusion syndrome” – in some patients with MI and reperfusion a fulminant HF is developed afterwards. Sarvedilol limits the “oxygen shock” on the cells;
– Improving the opportunities for the production of nitric oxide.
What is the importance of the alpha-1 blockade induced by carvedilol?
In HF the heart works with a decreased flow, against an increased peripheral vascular resistance.
By blocking the alpha-1-adrenergic receptors in the periphery, carvedilol causes vasodilation, reduces the peripheral vascular resistance and hence decreases the afterload of the heart, therefore, limiting the hypertrophy of the left ventricle and the subsequent diastolic dysfunction.
Hence the additional effect of carvedilol on the development of HF – functional class improvement, and improvement of the quality of life.
Tchaikapharma – High Quality Medicines Inc. produces licensed Dilatrend (carvedilol) and is a Marketing Authorization Holder of the product.
Dilatrend has been in the list of NHIF since the 16th of November 2014, with the following codes:
Dilatrend 6.25 mg x 28 tabl. – CG 221
Dilatrend 12.5 mg x 28 tabl. – CG 220
Dilatrend 25 mg x 28 tabl. – CG 219