Drug Evaluation Cardiovascular & Renal: Carvedilol: a new paradigm for the treatment of congestive heart failure

Abstract

Carvedilol is a vasodilating β-blocker with antioxidant activity, and is currently approved for use in hypertension, angina and congestive heart failure in many countries. Carvedilol is a non-selective β₁-and β₂-adrenoceptor antagonist, an α₁-adrenoceptor antagonist (which produces vasodilation) and a potent antioxidant. The antioxidant actions of carvedilol have been demonstrated both in vitro and in vivo, including humans at therapeutic doses of the drug. Carvedilol possesses cardioprotective actions that result from the potent anti-ischaemic, antiarrhythmic and anti-apoptotic effects of the drug that have been demonstrated in a variety of experimental models of myocardial injury. In Phase III clinical trials in patients with congestive heart failure, carvedilol has been shown to reduce mortality by 65% (p < 0.0001) and to reduce hospitalisation significantly. As a result of the efficacy of carvedilol in reducing morbidity and mortality in patients with congestive heart failure, and in improving the quality of life in these patients, a new era in the management of congestive heart failure has begun.