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(Circulation. 2000;102:484.)
© 2000 American Heart Association, Inc.

Editorial

What Type of ß-Blocker Should Be Used to Treat Chronic Heart Failure?

Michael R. Bristow, MD, PhD

From the Division of Cardiology, University of Colorado Health Sciences Center, Denver, CO 80262

Correspondence to Michael R. Bristow, MD, PhD, the Division of Cardiology, University of Colorado Health Sciences Center, Denver, CO 80262.

Key Words: Editorials • heart failure • receptors, adrenergic, beta • hemodynamics

The success of ß-blocking agents in treating mild to moderate heart failure has generated a debate over whether the salutary results are strictly a class effect caused by ß₁-adrenergic receptor antagonism or if additional pharmacological properties of some compounds increase the efficacy inherent in all agents that block ß₁-receptors. The diverse adrenergic receptor activities of ß-blocking agents that have been used successfully to treat chronic heart failure, the emerging role of the various adrenergic receptor pathways in the mediation of cardiomyopathic phenotypes in model systems (recently reviewed in Circulation¹ ), and the vigor of pharmaceutical company scientific marketing all contribute to the legitimacy and decibel level of the discussion. The original, largely theoretical arguments^{2 3 4} have led to increasingly more rigorous tests of the hypothesis that clinically important differences exist among these agents. In this issue of Circulation, Metra et al⁵ report the largest of these tests to date. They provide a direct comparison of the of the ß₁-adrenergic-receptor–selective, "second generation" ß-blocker metoprolol with the nonselective ß/-blocker, "third generation" compound carvedilol.

Metra et al⁵ measured left ventricular (LV) functional and hemodynamic effects in 150 subjects with heart failure who were prospectively randomized 1:1 to the recommended doses of each agent. Previous, smaller studies had reported either subtle differences in favor of carvedilol^{4 6} or no difference⁷ between the 2 agents. Their data⁵ indicate that compared with metoprolol, carvedilol provides, as expected, a greater degree of ß-blockade. Also, as expected and as previously reported in individual clinical trials,^{8 9} . . . [Full Text of this Article]

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