The Development of Tolerance to α1-Adrenoceptor Blockade With Chronic Carvedilol Treatment
Status:
Completed
Trial end date:
2008-08-01
Target enrollment:
Participant gender:
Summary
There is now strong evidence from clinical trials that carvedilol therapy in heart failure is
superior to therapy with metoprolol. Not only does carvedilol have superior effects on lipid
profiles, insulin sensitivity, renal blood flow, and reversal of pathologic remodeling but
also its use is associated with fewer deaths compared to metoprolol. These facts make it
important to carefully define how metoprolol and carvedilol are pharmacologically different.
One potential difference is α1-AR antagonism. If we demonstrate that these α1-AR effects are
preserved with chronic therapy, then α1-AR blockade may have an important role in carvedilol
favorably altering the natural history of heart failure. On the other hand, if we demonstrate
that tolerance to the α1-AR blockade effect of carvedilol decreases with time, then it would
be unlikely that this pharmacologic property contributes to the efficacy of carvedilol. In
such a case other pharmacologic properties, such as antioxidant activity, would appear to be
important. These results will help guide future studies into CHF and AR blockade.