Abstract
Aim. To compare antihypertensive and metabolic effects of long-term treatment with carvedilol or bisoprolol in patients with arterial hypertension (HT) of 1-2 degree and overweight/obesity. Material and methods. A total of 105 patients were enrolled into open-label comparative stepped trial in two parallel groups. The patients were randomized into two groups: the group 1 (n=53) started treatment with carvedilol 25 mg daily and the group 2 (n=52) – with bisoprolol 5 mg daily. If the effect was insufficient a dose of a beta-blocker was doubled, then amlodipine was added in the dose of 5 mg daily with its further increase if necessary or indapamide in dose 1.5 mg daily. The follow-up for each patient was 24 weeks. At the start and then 12 and 24 weeks later the frequency of target blood pressure (BP) achievement, body mass index, biochemical indices, ECG and treatment safety were evaluated. Results. Significant distinctions in antihypertensive therapy effect between the groups were absent (ΔBP=-29.5±11.3/17.8±8.4 and -30.4±12.8/18.7±8 mm Hg for groups 1 and 2, respectively , p<0.001 for the both groups) as well as the necessity for additional therapy. All the patients completed the study had achieved target BP level. The patients of the both groups decreased body mass index after 6-month treatment (-0.57±1.1, p=0.001 and -0.53±0.8 kg/m2, p<0.001 for groups 1 and 2, respectively). Patients of the group 1 demonstrated significant reduction in fasting plasma glucose level (-0.45±1.2 mM/l, p=0.01), uric acid (-0.05±0.01 mM/l, p<0.001) and low-density lipoprotein cholesterol level (-0.28±0.9 mM/l, p<0.05) as well as a trend for HOMA index decrease. Serum creatinine level increased in patients of the group 2 (6.35±22.4 mcM/l, p=0.05) with no significant dynamics in metabolic indices. Glomerular filtration rate did not change significantly in the group 1, while there was significant decrease in the group 2 (Δ-3.8±15.2 ml/min/1,73m2, р=0.01). The groups did not differ in adverse events incidence and severity. Conclusion. The CABRIOLET study showed similar antihypertensive efficacy of carvedilol and bisoprolol in HT patients with abdominal obesity and confirmed favorable metabolic effects of long-term treatment with carvedilol, unlike bisoprolol.
Highlights
Arterial hypertension (HT) is considered as the most common cardiovascular diseases (CVD) risk factor
Betaadrenoblockers (BAB) decrease cardiovascular mortality in HT patients but in a lesser degree than one could expect [1]. This can be possibly explained by their influence on some of cardiovascular risk factors such as: dyslipidemia, overweight, hyperglycemia
One of trials demonstrated decrease in new-onset diabetes mellitus (DM) incidence rate in patients with heart failure treated with carvedilol [7]
Summary
Arterial hypertension (HT) is considered as the most common cardiovascular diseases (CVD) risk factor. Betaadrenoblockers (BAB) decrease cardiovascular mortality in HT patients but in a lesser degree than one could expect [1] This can be possibly explained by their influence on some of cardiovascular risk factors such as: dyslipidemia, overweight, hyperglycemia. Combination of BAB with thiazide diuretics is not welcome in such patients as “thiazide diuretics, often prescribed with BAB in trials, led to relative increase in newonset DM cases This may not be applied to BAB with vasodilating effects, such as carvedilol and nebivolol” [1]. One of trials demonstrated decrease in new-onset DM incidence rate in patients with heart failure treated with carvedilol [7] This may be probably explained by its influence on peripheral vascular resistance due to a1-adrenoceptors blockade [8,9]. That is why comparative study of efficacy and safety of treatment with carvedilol (a, β-adrenoblocker) and bisoprolol (cardioselective β1-adrenoblocker) in men with elements of metabolic syndrome is of great practical interest
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