Objective To systematically review the effectiveness and safety of carvedilol and metoprolol for primary hypertension. Methods Such databases as PubMed, EMbase, Web of Science, The Cochrane Library, CBM, CNKI, VIP and WanFang Data were electronically searched for relevant studies from inception to December, 2012. Two reviewers independently screened literature according to the inclusion and exclusion criteria as well as the methods recommended by the Cochrane Collaboration, extracted data, and assessed the methodological quality of the included studies. Then, meta-analysis was performed using RevMan 5.1 software. Results 7 trials involving 2 243 patients were included. The results of meta-analysis showed no significant difference in the reduction of systolic blood pressure, diastolic blood pressure, and heart rate between the carvedilol and metoprolol groups (Pgt;0.05). However, the carvedilol group was superior to the metoprolol group in improving serum triglyceride (MD=0.75, 95%CI 0.45 to 1.04, Plt;0.000 01), serum cholesterol (MD=0.38, 95%CI 0.19 to 0.56, Plt;0.000 1), serum low density lipoprotein (MD=0.59, 95%CI 0.33 to 0.85, Plt;0.000 01), serum high density lipoprotein (MD= –0.09, 95%CI –0.16 to –0.02, P=0.008), and fasting plasma glucose (MD=0.36, 95%CI 0.21 to 0.51, Plt;0.000 01). In addition, the incidence of drug related adverse reaction was significantly lower in the carvedilol group (OR=0.39, 95%CI 0.24 to 0.63, P=0.000 1). Conclusion Based on current evidence, carvedilol tends to have beneficial effects on metabolic parameters and safety profiles, compared with metoprolol.
目的 观察β受体阻滞剂卡维地洛和美托洛尔对高血压性心脏病患者左室心肌质量的影响。 方法 将2005年6月－2007年6月收治的260例原发性高血压性心脏病患者，随机分为A、B两组，每组130例。均停用其他降压药物1周后，A组服用卡维地洛，B组服用美托洛尔。两组第1周均服用12.5 mg，2次/d；无明显心动过缓或血压明显下降者，第2周改服25 mg，2次/d，必要时均加用硝苯地平控释片以血压降低至正常范围，心率≥55次/min为宜，每2周加量，最大剂量为50 mg ，2次/d。疗程6个月。观察指标：分别于用药前后测定患者左室舒张末内径（LVDd）、左室射血分数（LVEF）、室间隔厚度（LVST）及左室后壁厚度（PWT）。计算左室心肌质量（LVMW）、左室心肌质量指数（LVWI）。 结果 A、B两组在试验前后分别作自身对比，LVDd减小，LVST及PWT变薄，LVEF增高，LVWI降低差异有统计学意义（P＜0.01）；A、B两组在试验后对比，差异无统计学意义（P＞0.05）。 结论 卡维地洛、美托洛尔应用于高血压心脏病患者，可有效降低血压和减慢心率，减少心肌耗氧量，降低左室负荷及神经激素的活动，减轻左室肥厚，减低心肌质量。
ObjectiveTo investigate the clinical efficacy and safety of carvedilol in the treatment of arrhythmia in patients with hypertension complicated with diabetes mellitus. MethodsWe selected the patients with hypertension complicated with diabetes mellitus who were hospitalized in the Harrison International Peace Hospital Affiliated to Hebei Medical University for treatment from Oct. 2011 to Oct. 2013. The cases were divided into a trial group and a control group. The control group was given routine treatment (eg., hypoglycaemic drugs, angiotensin converting enzyme inhibitors). On the basis of the same treatment of the control group, the trial group was given carvedilol. The efficacy and adverse reaction were observed, recorded and then analyzed between the two groups. ResultsA total of 140 patients were included (70 cases in each group). With the loss of 10 cases in the control group, the data of 70 cases in the trial group and 60 cases in the control group were finally analyzed. The results showed that the trial group was superior to the control group in the total effectiveness (χ2=8.320, P=0.004) and the dynamic ECG improvement of premature ventricular contraction (χ2=5.333, P=0.014) with significant differences. Both groups were significantly improved in blood pressure and heart beats compared with the situation before treatment (Both P < 0.05), and the trial group was better than the control group with a significant difference. During the treatment, three cases in the trial group had mild gastrointestinal symptoms which spontaneously disappeared later. ConclusionThe clinical effectiveness of carvedilol for arrhythmia in patients with hypertension complicated with diabetes mellitus is significant. It is safe and effective which is recommended in clinical application.