Preview

Rational Pharmacotherapy in Cardiology

Advanced search

COMPARISON OF THE INFLUENCE OF LONG-TERM TREATMENT BASED ON CARVEDILOL OR BISOPROLOL ON METABOLIC PARAMETERS IN HYPERTENSIVE PATIENTS WITH OVERWEIGHT OR OBESITY RESULTS OF THE RANDOMIZED OPEN-LABEL PARALLEL-GROUPS STEPPED TRIAL CABRIOLET (PART I)

https://doi.org/10.20996/1819-6446-2012-8-4-488-499

Full Text:

Abstract

Aim. To compare antihypertensive and metabolic effects of long-term treatment with carvedilol or bisoprolol in patients with arterial hypertension (HT) of 1-2 degree and overweight/obesity. Material and methods. A total of 105 patients were enrolled into open-label comparative stepped trial in two parallel groups. The patients were randomized into two groups: the group 1 (n=53) started treatment with carvedilol 25 mg daily and the group 2 (n=52) – with bisoprolol 5 mg daily. If the effect was insufficient a dose of a beta-blocker was doubled, then amlodipine was added in the dose of 5 mg daily with its further increase if necessary or indapamide in dose 1.5 mg daily. The follow-up for each patient was 24 weeks. At the start and then 12 and 24 weeks later the frequency of target blood pressure (BP) achievement, body mass index, biochemical indices, ECG and treatment safety were evaluated. Results. Significant distinctions in antihypertensive therapy effect between the groups were absent (ΔBP=-29.5±11.3/17.8±8.4 and -30.4±12.8/18.7±8 mm Hg for groups 1 and 2, respectively , p<0.001 for the both groups) as well as the necessity for additional therapy. All the patients completed the study had achieved target BP level. The patients of the both groups decreased body mass index after 6-month treatment (-0.57±1.1, p=0.001 and -0.53±0.8 kg/m2, p<0.001 for groups 1 and 2, respectively). Patients of the group 1 demonstrated significant reduction in fasting plasma glucose level (-0.45±1.2 mM/l, p=0.01), uric acid (-0.05±0.01 mM/l, p<0.001) and low-density lipoprotein cholesterol level (-0.28±0.9 mM/l, p<0.05) as well as a trend for HOMA index decrease. Serum creatinine level increased in patients of the group 2 (6.35±22.4 mcM/l, p=0.05) with no significant dynamics in metabolic indices. Glomerular filtration rate did not change significantly in the group 1, while there was significant decrease in the group 2 (Δ-3.8±15.2 ml/min/1,73m2, р=0.01). The groups did not differ in adverse events incidence and severity. Conclusion. The CABRIOLET study showed similar antihypertensive efficacy of carvedilol and bisoprolol in HT patients with abdominal obesity and confirmed favorable metabolic effects of long-term treatment with carvedilol, unlike bisoprolol.

About the Authors

S. Y. Martsevich
State Research Center for Preventive Medicine
Russian Federation

PhD, MD, Professor , Head of Department of Preventive Pharmacotherapy



S. N. Tolpygina
State Research Center for Preventive Medicine
Russian Federation
PhD, MD, Leading researcher of Department of Preventive Pharmacotherapy


References

1. 2007 ESH-ESC Practice Guidelines for the Management of Arterial Hypertension: ESH-ESC Task Force on the Management of Arterial Hypertension. J Hypertens 2007;25(9):1751–62.

2. Shuetze G., Sabin G., Janitzki I., Scherhag A. Treatment of essential hypertension with carvedilol: the results of open prospective study in more than 10000 patients. Perfusion 2003;16:424–429.

3. Marchi F., Ciriello G. Efficacy of carvedilol in mild to moderate essential hypertension and effects on microalbuminuria: a multicentre, randomized, open-label controlled study versus atenolol. Adv Ther 1995;12:212–221.

4. Giugliano D, Acampora R, Marfella R et all. Metabolic and cardiovascular effects of carvedilol and atenolol in non-insulin-dependent diabetes mellitus and hypertension. A randomized, controlled trial. Ann Intern Med 1997;126(12):955–959.

5. Shal'nova S.A., Martsevich S.Iu., Deev A.D., et al. First results of open randomized clinical study of Acridilol in combination therapy of patients with arterial hypertension and obesity or type 2 diabetes (Mellitus-Open Multicenter Clinical Study ACCORD). Kardiologiia 2008;48(8):28–33. Russian (Шальнова С.А., Марцевич С.Ю., Деев А.Д. и др. Первые результаты многоцентрового рандомизированного клинического исследования по применению препарата Акридилол® в комбинированной терапии у больных артериальной гипертонией и ожирением или сахарным диабетом 2-го типа (АККОРД). Кардиология 2008;48(8):28–33).

6. Martsevich S.Y., Kutishenko N.P., Shilova E.V. et al. on behalf of working group on CAMELLIA trial. Comparison of therapies based on carvedilol and metoprolol in hypertensive patients with overweight or obesity. The first results of CAMELLIA trial. Rational Pharmacother Card 2009;(1):23–27. Russian (Марцевич С.Ю., Кутишенко, Шилова Е.В., и др. от имени рабочей группы по проведению исследования «Камелия». Сравнение терапии, основанной на карведилоле или метопрололе, у больных артериальной гипертонией и избыточной массой тела/ожирением. Первые результаты исследования КАМЕЛИЯ. РФК 2009; (1): 23–27).

7. Torp-Pedersen C., Metra M., Charlesworth A. et al. COMET investigators. Effects of metoprolol and carvedilol on pre-existing and new onset diabetes in patients with chronic heart failure: data from the Carvedilol Or Metoprolol European Trial (COMET). Heart 2007;93(8):968–73.

8. Sponer G., Bartsch W., Strein K., et al. Pharmacological profile of carvedilol as a beta-blocking agent with vasodilating and hypotensive properties. J Cardiovasc Pharmacol 1987; 9(3):317–327.

9. Weber K., Bohmeke T., van der Does R., Taylor S.H. Comparison of the hemodynamic effects of metoprolol and carvedilol in hypertensive patients. Cardiovasc Drugs Ther 1996; 10(2):113–117.

10. Lysko P.G., Webb C.L., Gu J.L., et al. A comparison of carvedilol and metoprolol antioxidant activities in vitro. J Cardiovasc Pharmacol 2000;36(2):277–281.

11. Yue TL. Antioxidant action of carvedilol. A potential role in treatment of heart failure. Heart Failure Reviews 1999;4:39–51.

12. Chazova I.E., Ratova L.G. Combination therapy of hypertension. Moscow: Media Medica; 2007. Russian (Чазова И.Е., Ратова Л.Г. Комбинированная терапия артериальной гипертонии. М.: Media Medica; 2007).

13. Byrd J.B., Zeng C., Tavel H.M. et al. Combination Therapy as Initial Treatment for Newly Diagnosed Hypertension. Am Heart J 2011; 62: 340–346.

14. National guidelines for diagnosis and treatment of metabolic syndrome (second revision). Available at: http://www.kardioforum.ru/files/articles/files/metab1-vse.pdf. Date of access: 05/08/2012. Russian (Национальные рекомендации по диагностике и лечению метаболического синдрома (Второй пересмотр). Доступно на: http://www.kardioforum.ru/files/articles/files/metab1-vse.pdf. Дата доступа: 05.08.2012).

15. Bakris GL, Fonseca V, Katholi RE et al. Differential Effects of І-Blockers on Albuminuria in Patients With Type 2 Diabetes. Hypertension 2005; 46: 1309–1315.

16. Fonarow G.C., Deedwania P., Fonseca V. et al. Differential effects of extended-release carvedilol and extended-release metoprolol on lipid profiles in patients with hypertension: results of the Extended-Release Carvedilol Lipid Trial. J Am Soc Hypertens 2009; 3(3): 210–20.

17. Bell D.S., Bakris G.L., McGill J.B. Comparison of carvedilol and metoprolol on serum lipid concentration in diabetic hypertensive patients. Diabetes Obes Metab 2009; 11: 3: 234–8.

18. Singh D, Chander V., Chopra K. Carvedilol, an antihypertensive drug with antioxidant properties, protects against glycerol-induced acute renal failure. Am J Nephrol 2003; 23: 415–421.


For citation:


Martsevich S.Y., Tolpygina S.N. COMPARISON OF THE INFLUENCE OF LONG-TERM TREATMENT BASED ON CARVEDILOL OR BISOPROLOL ON METABOLIC PARAMETERS IN HYPERTENSIVE PATIENTS WITH OVERWEIGHT OR OBESITY RESULTS OF THE RANDOMIZED OPEN-LABEL PARALLEL-GROUPS STEPPED TRIAL CABRIOLET (PART I). Rational Pharmacotherapy in Cardiology. 2012;8(4):488-499. (In Russ.) https://doi.org/10.20996/1819-6446-2012-8-4-488-499

Views: 482


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


ISSN 1819-6446 (Print)
ISSN 2225-3653 (Online)