Key result
Carvedilol achieved target blood pressure levels in 96.2% of patients compared to 95.5% with metoprolol (p=0.85), with favorable effects on metabolic indices despite higher costs.
Why the study?
Does carvedilol improve metabolic indicators and reduce expected cardiovascular risk more cost-effectively than metoprolol in patients with hypertension and overweight/obesity?
RCT (n=320)
randomly split
Does carvedilol improve metabolic indicators and reduce expected cardiovascular risk more cost-effectively than metoprolol in patients with hypertension and overweight/obesity?
While carvedilol therapy has a higher cost than metoprolol for achieving target blood pressure, it provides superior metabolic benefits and a greater reduction in expected 10-year cardiovascular risk in hypertensive patients with metabolic risk factors.
Answers are grounded in this paper and cite their sources.
Carvedilol may be preferred over metoprolol in obese hypertensives for metabolic benefits despite higher cost; extends beta-blocker comparative data beyond BP equivalence.
Aim. To perform cost-effectiveness analysis of 24 weeks antihypertensive therapy based on carvedilol or metoprolol in patients with arterial hypertension (HT) 1-2 degrees and overweight/obesity. To assess effects of carvedilol therapy on 10-year expected risk of cardiovascular complications (CVC). Material and methods. Patients with HT and overweight/obesity (n=320) were included into the study and randomly split in two groups. Patients of the first group (n=160) received carvedilol as a basic therapy and patients of the second group (n=160) — metoprolol. Both groups of the patients were comparable on key clinical characteristics. Results. In 24 weeks of treatment systolic and diastolic blood pressure (BP) decreased significantly in comparison with the baseline level (p<0.0001). Dose doubling of beta-blockers was required more often in patients treated with carvedilol. At the same time a combined antihypertensive therapy of the patients treated with carvedilol was required less (p>0.05). Target BP levels were achieved in carvedilol and metoprolol groups in 96.2and 95.5% of patients respectively (p=0.85). Carvedilol had better effect on plasma metabolic indicators such as glucose (p<0.01), lipid profile, uric acid level. Reduction in expected 10-year risk of death was more pronounced in 24 weeks carvedilol treatment. Cost of target BP level achievement was approximately 2.5 times higher in carvedilol group than this in metoprolol group. However cost of additional therapy was higher in metoprolol group. 1% reduction of the 10-year expected risk of CVC death cost 1 847 rubles in carvedilol therapy. Conclusion. Carvedilol therapy (vs metoprolol one) has a higher cost under comparable efficacy. Additional expenses are compensated with the favorable effect on metabolic indices and a more pronounced effect on reduction in the 10-year expected risk of CCO death. That is why carvedilol can be recommended to patients with HT and metabolic risk factors. Longer studies are necessary to assess an effect of carvedilol therapy on prognosis in patients with HT and concomitant metabolic disorders.
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Martsevich et al. (2010) conducted an RCT in Arterial hypertension and overweight/obesity (n=320). Carvedilol vs. Metoprolol was evaluated on Target blood pressure level achievement (p=0.85). Carvedilol achieved target blood pressure levels in 96.2% of patients compared to 95.5% with metoprolol (p=0.85), with favorable effects on metabolic indices despite higher costs.
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