Clinical trials of carvedilol in heart failure

Carvedilol is a non-selective α1 and β-adrenergic antagonist with antioxidant properties. This novel, competitive antagonist has been studied in 8 placebo-controlled clinical trials involving over 1800 heart failure patients with systolic dysfunction in varying degrees of severity. Overall, carvedilol is well-tolerated in heart failure patients, with a predictable reduction in heart rate and favorable hemodynamic actions. The overall incidence of side effects including hypotension, dizziness, bradycardia and worsening heart failure are no worse than placebo, and can be minimized with careful titration. Improvement in left ventricular ejection fraction has been observed with carvedilol in all studies. A significant reduction in the risks of dying or being hospitalized has also been demonstrated. Some studies have demonstrated improvements in clinical parameters such as symptoms and exercise tolerance, but these benefits have been more difficult to demonstrate conclusively. These clinical trials have established an important role of carvedilol in the management of heart failure. The results from the recent survival trials of beta-adrenergic antagonists have confirmed the mortality benefit of this class of drug in the management of patients with heart failure.