Abstract 2499: Effects of Nebivolol versus Carvedilol in Hypertensive Patients with Chronic Heart Failure
BACKGROUND Beta-blockers improve left ventricular (LV) systolic function and prognosis in patients with chronic heart failure. Both carvedilol and nebivolol have hemodynamic and clinical benefits in chronic heart failure (CHF), but it is unknown whether their pleiotropic properties may play a role in different subgroups of patients with CHF.
OBJECTIVE: To compare the effects of nebivolol and carvedilol on LV function and clinical outcome in patients with chronic heart failure and reduced LV systolic function.
METHODS: 160 hypertensive CHF patients, LV ejection fraction (EF) ≤ 40% and in New York Heart Association (NYHA) functional class II or III were randomly assigned to receive carvedilol or nebivolol therapy for 24 months. At baseline and after 24 months of treatment, all patients underwent clinical evaluation: echocardiogram and 6-minute walking test.
RESULTS: Compared with baseline values LV end-systolic diameter decreased and LVEF increased by a similar extent in both carvedilol (from 69+/- 27 mm to 61 +/- 27 mm and from 37% +/- 6% to 42% +/- 9%, p < 0.05) and nebivolol group (from 72 +/- 35 mm to 66 +/- 32mm and from 34% +/- 7% to 38% +/- 10%, p < 0.05) HR decreased in both groups (from 83 +/- 20 bpm to 66 +/- 11 bpm for carvedilol and from 81 +/- 15 bpm to 65 +/- 11 bpm for nebivolol; p < 0.001 vs baseline for both groups). A reduction in mean NYHA functional class from baseline was observed in both groups (from 2.5 +/- 0.5 to 2.2 +/-0.5, p < 0.05 for carvedilol and from 2.3 +/- 0.4 to 2.2 +/- 0.5, p < 0.05 for nebivolol. The 6-minute walking showed a significant increase in the walking distance in both groups. During 24 months 4 patients in the nebivolol and 3 in the carvedilol group died. The overall rate of cardiac events was 22% and 26% in the nebivolol and carvedilol group respectively.
CONCLUSION: Nebivolol is as effective as carvedilol in patients with symptomatic chronic heart failure and reduced LV systolic function.