Switching Beta-Blockers Tied to Airway Function Changes

Heart failure patients, some with COPD, switched between carvedilol, metoprolol, bisoprolol

TUESDAY, April 20 (HealthDay News) -- Switching between the nonselective beta-blocker carvedilol and the β1-selective beta-blockers metoprolol succinate and bisoprolol is well tolerated but leads to changes in airway function in patients with chronic heart failure, particularly those with chronic obstructive pulmonary disease (COPD), according to research published in the April 27 issue of the Journal of the American College of Cardiology.

Andrew Jabbour, of St. Vincent's Hospital in Sydney, Australia, and colleagues analyzed data from a randomized, open-label, triple-crossover trial involving 51 participants (mean age, 66 years) using optimal therapy for chronic heart failure. Subjects received carvedilol, metoprolol, and bisoprolol for six weeks each before switching back to their original beta-blocker.

The researchers found lower N-terminal prohormone brain natriuretic peptide with carvedilol compared to the other drugs, but it returned to baseline level with continuation of the initial beta-blocker. Central augmented pressure was lowest with carvedilol. In those with COPD, forced expiratory volume in one second was lowest with carvedilol, and highest with bisoprolol. The switches between drugs were well tolerated.

"Switching between β1-selective beta-blockers and the nonselective beta-blocker carvedilol is well tolerated but results in demonstrable changes in airway function, most marked in patients with COPD," the authors write.

The study was supported by a grant from Pfizer Australia. Several co-authors disclosed relationships with Pfizer and/or other pharmaceutical companies.

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