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Comparative dose titration responses to the introduction of bisoprolol or carvedilol in stable chronic systolic heart failure.

Author(s): Hamaad A, Lip GY, Nicholls D, MacFadyen RJ

Affiliation(s): University Department of Medicine, City Hospital, Dudley Road, Birmingham, B18 7QH, UK.

Publication date & source: 2007-12, Cardiovasc Drugs Ther., 21(6):437-44.

Publication type: Comparative Study; Randomized Controlled Trial

INTRODUCTION: Several beta blocking drugs (BB) reduce mortality in systolic heart failure (LVSD). We have compared the initial response to introduction of carvedilol and bisoprolol during the standard dose titration protocols for each drug. METHODS: Approximately 31 unselected patients with stable LVSD were randomised to either carvedilol or bisoprolol measuring blood pressure, heart rate responses and both time and frequency domain heart rate variability (HRV). RESULTS: One subject died; five withdrew due to intolerable BB related side effects. Carvedilol (n = 13) and bisoprolol (n = 12) attained similar maximal heart rate reduction and induced comparable falls in systolic and diastolic blood pressure. Higher carvedilol doses were associated with lower blood pressure compared to baseline. Individual time domain HRV indices remained unchanged over the initial titration period. Significant increases in triangular Index (TI) were seen with both BB. Carvedilol demonstrated greater (but non-significant) rises in TI compared to Bisoprolol. CONCLUSIONS: In this study we found similar degrees and rate of onset of HR, HRV and BP response to both carvedilol and bisoprolol in treated LVSD patients. Carvedilol appears to show superior HRV rises compared to bisoprolol during initial titration. Any significant increases in HRV attributable to carvedilol compared to bisoprolol may emerge over a longer treatment interval in LVSD.

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