Betaxolol is equivalent to carvedilol in patients with heart failure NYHA II or III: result of a randomized multicenter trial (BETACAR Trial).
Author(s): Figulla HR, Krzeminska-Pakula M, Wrabec K, Chochola J, Kalmbach C, Fridl P
Affiliation(s): Universitatsklinikum Jena, Germany. Hans.Figulla@med.uni-jena.de
Publication date & source: 2006-11-10, Int J Cardiol., 113(2):153-60. Epub 2005 Sep 12.
Publication type: Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't
BACKGROUND: In a recent COMET trial (Lancet 362, 2003:7-13) it could be demonstrated that carvedilol < or = 50 mg/d was superior to metoprolol tartrate < or = 100 mg/d in the treatment of heart failure patients NYHA II-IV. OBJECTIVES: It was investigated whether the superiority of carvedilol with its beta1, beta2 and alpha-blocking potency will persist in a comparison to a highly selective beta1-blocker with a long plasma half-time such as betaxolol. METHODS: 255 pts. with NYHA II or III heart failure were double-blind randomized and uptitrated to either carvedilol 25 mg bid (n=131) or betaxolol 20 mg od (n=124). RESULTS: Within 8 months left ventricular ejection fraction (LVEF) increased to the same extent from 30% to 43% (carvedilol) or 31% to 43% (betaxolol) as primary endpoint (ns). 13% of the carvedilol (CAR) patients versus 15% of the betaxolol patients (BET) suffered either from cardiac death or recurrent hospitalizations (cardiac death n=6 (CAR), n=2 (BET), ns). The mean increase in the 6-min walk test was 63 m with CAR and 61 m with BET and the Minnesota living with heart failure questionnaire improved in both groups (ns). Heart rate reduction was pronounced in both groups: CAR 13.1 beats/min, BET 13.6 beats/min. CONCLUSIONS: The long acting highly selective beta1-blocker betaxolol in an adequate dosage is not inferior to carvedilol in terms of exercise tolerance, safety and effects on left ventricular function.