The Journal of Informed Pharmacotherapy 2003;14:150.
Reviewer: James McCormack, B.Sc. (Pharm), Pharm. D.
Reviewer's email address: firstname.lastname@example.org
Reviewer's profession/specialty: Associate Editor, Journal of Informed Pharmacotherapy
Comparison of carvedilol and metoprolol on clinical outcomes in patients with chronic heart failure in the Carvedilol Or Metoprolol European Trial (COMET): randomised controlled trial. Poole-Wilson PA, Swedberg K, Cleland JG, Di Lenarda A, Hanrath P, Komajda M, Lubsen J, Lutiger B, Metra M, Remme WJ, Torp-Pedersen C, Scherhag A, Skene A. Lancet 2003;362:7-13 PubMed Citation
These investigators compared carvedilol to metoprolol in patients with chronic heart failure (CHF) and evaluated the impact on all-cause mortality and all-cause admission.
1511 patients with CHF (approximately 50% in both class II and class III) with a total cholesterol <6.5 mmol/L. Therapy for CHF prior to study enrollment included diuretics (99%), ACE inhibitors (92%), digoxin (60%), and lipid lowering agents (20%). The average age of the patients was 62 years and 20% were female.
Patients were randomized in a blinded fashion to receive either carvedilol (25 mg PO BID) or metroprolol (50 mg PO BID).
The mean study duration was 58 months.
There was no difference between groups in mean heart rate. The mean decrease in systolic blood pressure was 1.8 mmHg greater in the carvedilol group.
This study suggests that carvedilol reduces the chance of all deaths and cardiovascular deaths when compared to metoprolol in patients with Class II-III heart failure. The combination of all overall deaths and all-cause admissions (one of the primary endpoints) and overall serious adverse events was not different between the two agents.
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