Acute hemodynamic effects of moderate doses of nebivolol versus metoprolol in patients with systolic heart failure

OBJECTIVES: To determine the acute hemodynamic effect of moderate doses of nebivolol (vasodilating beta1-selective blocker) vs. metoprolol tartrate (non-vasodilating beta1-selective blocker) in systolic heart failure (SHF). MATERIAL AND METHODS: 20 stable patients with SHF (left ventricular (LV) ejection fraction < or = 35%) underwent right heart catheterization. Once a reproducible baseline was obtained, patients were randomized to 5 mg nebivolol PO (n = 10) or metoprolol tartrate 50 mg PO (n = 10). Hemodynamic studies were repeated hourly for the first 4 hours and at 6 hours. RESULTS: Both agents caused bradycardia. Nebivolol caused additionally a decrease in systemic vascular resistance (SVR) and no significant change in pulmonary capillary wedge pressure (PCWP), and cardiac output (CO). In contrast, metoprolol caused a deterioration of LV systolic function characterized by a decrease in cardiac output, and an increase in SVR and PCWP. CONCLUSIONS: Treatment initiation with moderate doses of nebivolol is not associated with the adverse hemodynamic effects of metoprolol in patients with SHF. These findings suggest that a long up-titration period may not be necessary with nebivolol.