PMID- 20413026
OWN - NLM
STAT- MEDLINE
DCOM- 20100506
LR  - 20181201
IS  - 1558-3597 (Electronic)
IS  - 0735-1097 (Linking)
VI  - 55
IP  - 17
DP  - 2010 Apr 27
TI  - Differences between beta-blockers in patients with chronic heart failure and 
      chronic obstructive pulmonary disease: a randomized crossover trial.
PG  - 1780-7
LID - 10.1016/j.jacc.2010.01.024 [doi]
AB  - OBJECTIVES: The purpose of this study was to determine the respiratory, 
      hemodynamic, and clinical effects of switching between beta1-selective and 
      nonselective beta-blockers in patients with chronic heart failure (CHF) and 
      chronic obstructive pulmonary disease (COPD). BACKGROUND: Carvedilol, metoprolol 
      succinate, and bisoprolol are established beta-blockers for treating CHF. Whether 
      differences in beta-receptor specificities affect lung or vascular function in 
      CHF patients, particularly those with coexistent COPD, remains incompletely 
      characterized. METHODS: A randomized, open label, triple-crossover trial 
      involving 51 subjects receiving optimal therapy for CHF was conducted in 2 
      Australian teaching hospitals. Subjects received each beta-blocker, dose-matched, 
      for 6 weeks before resuming their original beta-blocker. Echocardiography, 
      N-terminal pro-hormone brain natriuretic peptide, central augmented pressure from 
      pulse waveform analysis, respiratory function testing, 6-min walk distance, and 
      New York Heart Association (NYHA) functional class were assessed at each visit. 
      RESULTS: Of 51 subjects with a mean age of 66 +/- 12 years, NYHA functional class 
      I (n = 6), II (n = 29), or III (n = 16), and left ventricular ejection fraction 
      mean of 37 +/- 10%, 35 had coexistent COPD. N-terminal pro-hormone brain 
      natriuretic peptide was significantly lower with carvedilol than with metoprolol 
      or bisoprolol (mean: carvedilol 1,001 [95% confidence interval (CI): 633 to 
      1,367] ng/l; metoprolol 1,371 [95% CI: 778 to 1,964] ng/l; bisoprolol 1,349 [95% 
      CI: 782 to 1,916] ng/l; p < 0.01), and returned to baseline level on resumption 
      of the initial beta-blocker. Central augmented pressure, a measure of pulsatile 
      afterload, was lowest with carvedilol (carvedilol 9.9 [95% CI: 7.7 to 12.2] mm 
      Hg; metoprolol 11.5 [95% CI: 9.3 to 13.8] mm Hg; bisoprolol 12.2 [95% CI: 9.6 to 
      14.7] mm Hg; p < 0.05). In subjects with COPD, forced expiratory volume in 1 s 
      was lowest with carvedilol and highest with bisoprolol (carvedilol 1.85 [95% CI: 
      1.67 to 2.03] l/s; metoprolol 1.94 [95% CI: 1.73 to 2.14] l/s; bisoprolol 2.0 
      [95% CI: 1.79 to 2.22] l/s; p < 0.001). The NYHA functional class, 6-min walk 
      distance, and left ventricular ejection fraction did not change. The beta-blocker 
      switches were well tolerated. CONCLUSIONS: Switching between beta1-selective 
      beta-blockers and the nonselective beta-blocker carvedilol is well tolerated but 
      results in demonstrable changes in airway function, most marked in patients with 
      COPD. Switching from beta1-selective beta-blockers to carvedilol causes 
      short-term reduction of central augmented pressure and N-terminal pro-hormone 
      brain natriuretic peptide. (Comparison of Nonselective and Beta1-Selective 
      Beta-Blockers on Respiratory and Arterial Function and Cardiac Chamber Dynamics 
      in Patients With Chronic Stable Congestive Cardiac Failure; Australian New 
      Zealand Clinical Trials Registry, ACTRN12605000504617).
CI  - Copyright (c) 2010 American College of Cardiology Foundation. Published by 
      Elsevier Inc. All rights reserved.
FAU - Jabbour, Andrew
AU  - Jabbour A
AD  - Cardiology Department, St. Vincent's Hospital, Liverpool Street, Sydney, New 
      South Wales 2010, Australia.
FAU - Macdonald, Peter S
AU  - Macdonald PS
FAU - Keogh, Anne M
AU  - Keogh AM
FAU - Kotlyar, Eugene
AU  - Kotlyar E
FAU - Mellemkjaer, Soren
AU  - Mellemkjaer S
FAU - Coleman, Cathie F
AU  - Coleman CF
FAU - Elsik, Maros
AU  - Elsik M
FAU - Krum, Henry
AU  - Krum H
FAU - Hayward, Christopher S
AU  - Hayward CS
LA  - eng
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - J Am Coll Cardiol
JT  - Journal of the American College of Cardiology
JID - 8301365
RN  - 0 (Adrenergic beta-Antagonists)
RN  - 0 (Carbazoles)
RN  - 0 (Propanolamines)
RN  - 0K47UL67F2 (Carvedilol)
RN  - 114471-18-0 (Natriuretic Peptide, Brain)
RN  - GEB06NHM23 (Metoprolol)
RN  - Y41JS2NL6U (Bisoprolol)
SB  - IM
MH  - Adrenergic beta-Antagonists/administration & dosage/*therapeutic use
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Bisoprolol/*therapeutic use
MH  - Carbazoles/*therapeutic use
MH  - Carvedilol
MH  - Chronic Disease
MH  - Cross-Over Studies
MH  - Echocardiography
MH  - Female
MH  - Heart Failure/*drug therapy/physiopathology
MH  - Humans
MH  - Male
MH  - Metoprolol/*analogs & derivatives/therapeutic use
MH  - Middle Aged
MH  - Natriuretic Peptide, Brain/blood
MH  - Propanolamines/*therapeutic use
MH  - Pulmonary Disease, Chronic Obstructive/*complications/physiopathology
MH  - Pulse
MH  - Respiratory Function Tests
MH  - Walking
EDAT- 2010/04/24 06:00
MHDA- 2010/05/07 06:00
CRDT- 2010/04/24 06:00
PHST- 2009/11/09 00:00 [received]
PHST- 2010/01/08 00:00 [revised]
PHST- 2010/01/11 00:00 [accepted]
PHST- 2010/04/24 06:00 [entrez]
PHST- 2010/04/24 06:00 [pubmed]
PHST- 2010/05/07 06:00 [medline]
AID - S0735-1097(10)00693-5 [pii]
AID - 10.1016/j.jacc.2010.01.024 [doi]
PST - ppublish
SO  - J Am Coll Cardiol. 2010 Apr 27;55(17):1780-7. doi: 10.1016/j.jacc.2010.01.024.