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Differential Effects of Carvedilol and Metoprolol Succinate on Plasma Norepinephrine Release and Peak Exercise Heart Rate in Subjects With Chronic Heart Failure

Division of Cardiology, Albert Einstein College of Medicine, Bronx, tvittori@ montefiore.org

Ronald Zolty, MD

Division of Cardiology, Albert Einstein College of Medicine, Bronx

Michael E. Kasper, MD

Department of Medicine, University School of Medicine

Raj M. Khandwalla, MD

Department of Medicine, University School of Medicine

David S. Hirsh, MD

Division of Cardiology New York University School of Medicine

Chi-Hong Tseng, PhD

Department of Environmental Medicine and Medicine, University School of Medicine

Ulrich P. Jorde, MD

Division of Cardiology Columbia University Medical Center, New York

Kartikya Ahuja, MD

Division of Cardiology, Albert Einstein College of Medicine, Bronx

Dosing equivalency of carvedilol and metoprolol remains a debate. Degree of β₁-blockade is best assessed by blunting of the exercise-induced heart rate. Accordingly, the authors have investigated dosing equivalency by examining baseline and peak exercise heart rates and norepinephrine levels in subjects with chronic heart failure treated with carvedilol or metoprolol. Thirty-seven subjects treated with carvedilol (32.9 ± 3.5 mg; n = 23) or metoprolol succinate (XL) (96.4 ± 15.9 mg; n = 14) referred for cardiopulmonary exercise testing were studied prospectively. Carvedilol versus metoprolol XL subjects did not differ with respect to baseline heart rate (73 ± 2 vs 70 ± 3 bpm), or baseline plasma norepinephrine levels (597.5 ± 78.3 vs 602.1 ± 69.6 pg/mL), P = NS. However, despite similar peak exercise norepinephrine levels (2735.8 ± 320.1 vs 2403.1 ± 371.6 pg/mL), heart rate at peak exercise was higher in subjects receiving carvedilol (135 ± 4 bpm) than those receiving metoprolol XL (117 ± 6 bpm), P = 0.02. Similar norepinephrine release and more complete β₁-blockade is observed in well-matched subjects with chronic heart failure treated with a mean daily dose of metoprolol XL 96.4 mg compared with carvedilol 32.9 mg.

Key Words: heart failure • norepinephrine • metoprolol • carvedilol • heart rate • neurohormonal

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