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Though pharmacologically distinct, the beta-blockers carvedilol, metoprolol, and bisoprolol all are much more effective than placebo for treating chronic heart failure. In a randomized trial supported by the makers of carvedilol, researchers in Europe directly compared that drug (at a target dose of 25 mg twice daily) with metoprolol tartrate (at a target dose of 50 mg twice daily) in 3029 patients with chronic heart failure (mean age, 62; mean LV ejection fraction, 26%). Treatment lasted a mean of 58 months.
Estimated 5-year all-cause mortality incidence was 17% lower with carvedilol than with metoprolol (34% vs. 40%, P=0.002); the finding was consistent in predefined subgroups (e.g., age <65 vs. ≥65 and LVEF ≤25% vs. >25%). The carvedilol …