Contents

Differential Effect of Chronic Treatment with Metoprolol and Carvedilol on Systemic and Renal Hemodinamics in CHF

I. Jashi, B. Kobulia
M. Tsinamdzgvrishvili Institute of Cardiology, Tbilisi, Georgia

Both Metoprolol (M) and Carvedilol (C) produce hemodynamic and clinical benefits in patients with chronic heart failure (CHF): C exerts greater antiadrenergic effects than M, but it is unknown this pharmacological difference results in hemodynamic and clinical differences and renal function and hemodynamics between the 2 drugs.

96 male pts, aged 52 to 69, with CHF (II-III NYHA classification) due to chronic forms of coronary heart disease were examined. The pts were divided in 3 groups depending on the treatment: I group (29 pts) received cardiac glycosides and diuretics; M 25 mg bid was administered to 33 pts (II group) and C 12,5 mg bid – to 34 (III group). Acute pharmacological test followed by twelve-month course of M or C treatment was performed in each pts. Renal function was assessed by endogenous creatinine clearance, renal hemodynamics parameters – by cardiotrast clearance. Sodium and potassium ion concentration was determined by biochemical analyzer, sodium and water excretion was calculated by formula. Central hemodynamic was determined by echocardiography, tetrapolar rheography.

After twelve-month of treatment both M and C improved NYHA class, 6-minute walk distance, and quality-of-life scores (all p<0,05 from baseline), and there were no differences between the 2 treatments.

Increased glomerular filtration rate (GFR) and effective renal blood flow (ERBF) were observed in the course of treatment with M (GFR – 68+1 ml/min before treatment vs. 71+2 ml/min after treatment, p<0,05; ERBF – 633+18 ml/min vs. 770+14 ml/min, p<0,01, respectively). M increased renal sodium and water excretion accordingly by 38,1-84,6% and 26,4-70,8%. The renal vascular resistance decreased by 9%. The change in the C group was significantly greater than in the M group, especially about concerning ERBF and renal vascular resistance.

Beneficial effects of M or C on renal function and hemodynamic parameters were observed in pts with CHF, which appears to be not only the result of central hemodynamic changes, but in greater extent was due to direct renal action of M and C. Improved natriuresis and diuresis decrease the rigidity of vessel’s wall, which is marked in CHF due to high sodium concentration, and also decrease the compression of vessels due to interstitial edema. Decreased renal vascular resistance. This course the potentiation of vasodilatation.

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