Skip to main content
SpringerLink
Log in

Carvedilol: a review of its use in the management of heart failure

  • Review Article
  • Published:
Drugs & Therapy Perspectives Aims and scope Submit manuscript

Abstract

Heart failure (HF) is a major public health issue with an increasing burden worldwide. The abnormalities in cardiovascular reflexes are responsible for the sympathetic hyperactivity in HF. Interrupting the activated sympathetic nervous system with β-blockers is a promising approach to alter the natural course of HF. Carvedilol is a third-generation β-blocker that offers not only non-selective β- and α1-adrenoreceptor antagonism properties, but also multiple cardioprotective effects that are beneficial in HF management. Carvedilol is a well studied β-blocker with numerous reports of efficacy across all stages of HF, as well as HF in dialysis patients. The better therapeutic efficacy and tolerability profiles of carvedilol compared with β1-selective β-blockers should make carvedilol an attractive option in the management of HF.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Mann DL, Bristow MR. Mechanisms and models in heart failure: the biomechanical model and beyond. Circulation. 2005;111:2837–49.

    Article  PubMed  Google Scholar 

  2. Ghashghaei R, Yousefzai R, Adler E. Palliative care in heart failure. Prog Cardiovasc Dis. 2016;58(4):455–60.

  3. Mozzafarian D, Benjamin EJ, Go AS, et al. On behalf of the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics—2016 update: a report from the American Heart Association. Circulation. 2016;133:e38–360.

    Article  Google Scholar 

  4. Sakata Y, Shimokawa H. Epidemiology of heart failure in Asia. Circ J. 2013;77:2209–17.

    Article  PubMed  Google Scholar 

  5. Huffman MD, Prabhakaran D. Heart failure: epidemiology and prevention in India. Natl Med J India. 2010;23:283–8.

    PubMed  PubMed Central  Google Scholar 

  6. Watson AM, Hood SG, May CN. Mechanisms of sympathetic activation in heart failure. Clin Exp Pharmacol Physiol. 2006;33:1269–74.

    Article  CAS  PubMed  Google Scholar 

  7. Mazurek JA, Jessup M. Understanding heart failure. Card Electrophysiol Clin. 2015;7(4):557–75.

    Article  PubMed  Google Scholar 

  8. Parati G, Esler M. The human sympathetic nervous system: its relevance in hypertension and heart failure. Eur Heart J. 2012;33:1058–66.

    Article  CAS  PubMed  Google Scholar 

  9. Bristow MR. β-adrenergic receptor blockade in chronic heart failure. Circulation. 2000;101(5):558–69.

    Article  CAS  PubMed  Google Scholar 

  10. Fonarow GC. Role of carvedilol controlled-release in cardiovascular disease. Expert Rev Cardiovasc Ther. 2009;7(5):483–98.

    Article  CAS  PubMed  Google Scholar 

  11. Nichols AJ, Sulpizio AC, Ashton DJ, et al. In vitro pharmacologic profile of the novel β-adrenoceptor antagonist and vasodilator, carvedilol. Pharmacology. 1989;39(5):327–36.

    Article  CAS  PubMed  Google Scholar 

  12. Chen-Scarabelli C, Saravolatz L Jr, Murad Y, et al. A critical review of the use of carvedilol in ischemic heart disease. Am J Cardiovasc Drugs. 2012;12(6):391–401.

    CAS  PubMed  Google Scholar 

  13. Yancy CW, Jessup M, Bozkurt B, et al. 2016 ACC/AHA/HFSA focused update on new pharmacological therapy for heart failure: an update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Circulation. 2016;134(13):e282–93.

    Article  PubMed  Google Scholar 

  14. Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016;37(27):2129–200.

    Article  PubMed  Google Scholar 

  15. Packer M, Bristow MR, Cohn JN, et al. The effect of carvedilol on morbidity and mortality in patients with chronic heart failure. U.S. Carvedilol Heart Failure Study Group. N Engl J Med. 1996;334(21):1349–55.

    Article  CAS  PubMed  Google Scholar 

  16. Randomized, placebo-controlled trial of carvedilol in patients with congestive heart failure due to ischemic heart disease. Australia/New Zealand Heart Failure Research Collaborative Group. Lancet. 1997;349(9049):375–80.

  17. Poole-Wilson PA, Swedberg K, Cleland JG, et al. Comparison of carvedilol and metoprolol on clinical outcomes in patients with chronic heart failure in the Carvedilol or Metoprolol European Trial (COMET): randomized controlled trial. Lancet. 2003;362(9377):7–13.

    Article  CAS  PubMed  Google Scholar 

  18. Packer M, Fowler MB, Roecker EB, et al. Effect of carvedilol on the morbidity of patients with severe chronic heart failure: results of the carvedilol prospective randomized cumulative survival (COPERNICUS) study. Circulation. 2002;106(17):2194–9.

    Article  PubMed  Google Scholar 

  19. MERIT-HF Study Group. Effect of metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL Randomised Intervention Trial in Congestive Heart Failure (MERIT-HF). Lancet. 1999;353(9169):2001–7.

    Article  Google Scholar 

  20. CIBIS-II Investigators and Committees. The Cardiac Insufficiency Bisoprolol Study II (CIBIS-II): a randomised trial. Lancet. 1999;353(9146):9–13.

    Article  Google Scholar 

  21. Dargie HJ. Effect of carvedilol on outcome after myocardial infarction in patients with left-ventricular dysfunction: the CAPRICORN randomized trial. Lancet. 2001;357(9266):1385–90.

    Article  CAS  PubMed  Google Scholar 

  22. Benedict CR, Johnstone DE, Weiner DH, et al. Relation of neurohumoral activation to clinical variables and degree of ventricular dysfunction: a report from the Registry of Studies of Left Ventricular Dysfunction. SOLVD Investigators. J Am Coll Cardiol. 1994;23:1410–20.

    Article  CAS  PubMed  Google Scholar 

  23. Kobayashi M, Machida N, Mitsuishi M, et al. β-blocker improves survival, left ventricular function, and myocardial remodeling in hypertensive rats with diastolic heart failure. Am J Hypertens. 2004;17:1112–9.

    Article  CAS  PubMed  Google Scholar 

  24. Dobre D, van Veldhuisen DJ, DeJongste MJ, et al. Prescription of β-blockers in patients with advanced heart failure and preserved left ventricular ejection fraction. Clinical implications and survival. Eur J Heart Fail. 2007;9:280–6.

    Article  CAS  PubMed  Google Scholar 

  25. Hernandez AF, Hammill BG, O’Connor CM, et al. Clinical effectiveness of β-blockers in heart failure: findings from the OPTIMIZE-HF (Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure) Registry. J Am Coll Cardiol. 2009;53:184–92.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Yamamoto K, Origasa H, Hori M, J-DHF Investigators. Effects of carvedilol on heart failure with preserved ejection fraction: the Japanese Diastolic Heart Failure Study (J-DHF). Eur J Heart Fail. 2013;15(1):110–8.

  27. Yanagihara K, Kinugasa Y, Sugihara S, et al. Discharge use of carvedilol is associated with higher survival in Japanese elderly patients with heart failure regardless of left ventricular ejection fraction. J Cardiovasc Pharmacol. 2013;62:485–90.

    Article  CAS  PubMed  Google Scholar 

  28. Wali RK, Iyengar M, Beck GJ, et al. Efficacy and safety of carvedilol in treatment of heart failure with chronic kidney disease: a meta-analysis of randomized trials. Circ Heart Fail. 2011;4(1):18–26.

    Article  CAS  PubMed  Google Scholar 

  29. Stack AG, Bloembergen WE. A cross-sectional study of the prevalence and clinical correlates of congestive heart failure among incident US dialysis patients. Am J Kidney Dis. 2001;38:992–1000.

    Article  CAS  PubMed  Google Scholar 

  30. Tang CH, Wang CC, Chen TH, et al. Prognostic benefits of carvedilol, bisoprolol, and metoprolol controlled release/extended release in hemodialysis patients with heart failure: a 10-year cohort. J Am Heart Assoc. 2016;5(1):e002584.

  31. Cice G, Ferrara L, D’Andrea A, et al. Carvedilol increases two-year survival in dialysis patients with dilated cardiomyopathy: a prospective, placebo-controlled trial. J Am Coll Cardiol. 2003;41:1438–44.

    Article  CAS  PubMed  Google Scholar 

  32. Cice G, Ferrara L, Di Benedetto A, et al. Dilated cardiomyopathy in dialysis patients–beneficial effects of carvedilol: a double-blind, placebo-controlled trial. J Am Coll Cardiol. 2001;37(2):407–11.

  33. K/DOQI clinical practice guidelines for cardiovascular disease in dialysis patients. Am J Kidney Dis. 2005;45(4 Suppl 3):S1–153.

  34. COREG label. Package insert: http://www.accessdata.fda.gov/drugsatfda_docs/label/2015/020297s037lbl.pdf. Accessed 23 Aug 2016.

  35. Bakris GL, Fonseca V, Katholi RE, et al. Metabolic effects of carvedilol vs metoprolol in patients with type 2 diabetes mellitus and hypertension: a randomized controlled trial. JAMA. 2004;292:2227–36.

    Article  CAS  PubMed  Google Scholar 

  36. COREG CR label. Package insert: http://www.accessdata.fda.gov/drugsatfda_docs/label/2015/022012s021lbl.pdf Accessed 23 Aug 2016.

  37. Zebrack JS, Munger M, MacGregor J, et al. β-receptor selectivity of carvedilol and metoprolol succinate in patients with heart failure (SELECT trial): a randomized dose-ranging trial. Pharmacotherapy. 2009;29(8):883–90.

    Article  CAS  PubMed  Google Scholar 

  38. Bolling R, Scheller NM, Kober L, et al. Comparison of the clinical outcome of different β-blockers in heart failure patients: a retrospective nationwide cohort study. Eur J Heart Fail. 2014;16(6):678–84.

    Article  CAS  PubMed  Google Scholar 

  39. Church KM, Henalt R, Baker E, et al. Comparison of metoprolol succinate versus carvedilol in time to cardiovascular admission in a Veterans Affairs healthcare system: an observational study. Am J Health Syst Pharm. 2015;72(23 Suppl 3):S183–90.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Medical Affairs, Intas Pharmaceuticals Ltd., Ahmedabad, Gujarat, India

    Hiren Prajapati, Ramandeep Sharma & Dixit Patel

Authors
  1. Hiren Prajapati
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ramandeep Sharma
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Dixit Patel
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hiren Prajapati.

Ethics declarations

Conflict of interest

Hiren Prajapati, Ramandeep Sharma and Dixit Patel are salaried employees of Intas Pharmaceuticals Ltd., Ahmedabad, Gujarat, India.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Prajapati, H., Sharma, R. & Patel, D. Carvedilol: a review of its use in the management of heart failure. Drugs Ther Perspect 33, 147–152 (2017). https://doi.org/10.1007/s40267-016-0370-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40267-016-0370-x

Keywords

Search

Navigation