Effect of Beta-blockers in Patients with Chronic Heart Failure and COPD

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A study conducted by dr. Christopher Hayward and colleagues from St. Vincent's Hospital, Sydney, Australia, showed that patients with an unstable hemodynamic condition has a better tolerance with carvedilol therapy and patients with a history of respiratory disease (which need inhalation therapy) are more able to tolerate treatment with bisoprolol and metoprolol. This conclusion is the result of research conducted by Dr. Christopher Hayward and colleagues from St. Vincent's Hospital, Sydney, Australia. The results of this study have also been published in the Journal of the American College of Cardiology 2010, edition 27.
Carvedilol, which is included in the class of nonselective beta-blocker bisoprolol and / metoprolol, which include beta blockers selective and has long been used as a therapy for patients with chronic heart failure.
Carvedilol has more or less the same effectiveness, both the receptor beta-1 and beta-2 receptor alpha and against. Meanwhile, metoprolol and bisoprolol have a greater affinity to the receptors, especially beta-1 receptor and beta-2, which is mainly found in the lungs. Up to now, is not known with certainty whether there are specific differences between the beta-blocker class of non-selective with a selective pulmonary and vascular function in patients with chronic heart failure, particularly in patients with COPD (Chronic Obstructive Pulmonary Disease). In addition there is no clear security data when making the turn between beta-blocker therapy.
Research conducted by Dr. Christopher Hayward was peneltian design with a randomized, open, triple-crossover, involving 51 patients with stable heart failure who have received optimal therapy. Among these patients, a number of 35 patients also suffer from COPD. Beta-blocker therapy are comparable (carvedilol, bisoprolol and metoprolol) are given for 6 weeks, after which patients continued therapy with this type of beta-blockers that have been given before the study began. During the research carried echocardiography examination, examination of NT-proBNP (N-terminal pro-hormone brain natriuretic peptide, augmented central pressure) with a pulse waveform analysis, pulmonary function tests, tests in 6 minute walk distance and cardiac examination NYHA functional class (New York Heart Association) at each meeting.
The results show that NT-proBNP was significantly lower in the carvedilol treatment group compared with metoprolol and bisoprolol therapy group, and NT-proBNP levels returned to baseline when therapy was stopped and continued with the therapy before the study. Augmented central pulse pressure that describes the cardiac afterload, the lowest in the carvedilol group. In patients with COPD, FEV1 (forced expiratory volume in 1 second) is greater in patients treated with bisoprolol or metoprolol, compared with carvedilol (with the highest FEV1 in patients treated with bisoprolol).
Experts in this study concluded that the exchange between the drug class selective beta-blocker with a non-selective (carvedilol) can be well tolerated, but with changes in respiratory function, especially in patients with COPD. Exchange of drugs known as selective beta-blocker with beta-blockers, non-selective causes a decrease in NT-proBNP and augmented central pressure. Dr. Christopher said that in patients with unstable hemodynamic conditions will be better able to tolerate carvedilol.