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Carvedilol versus metoprolol for primary hypertension: a systematic review

Bibliographic details: Niu XW, Xu H, He SL, Chen D, Yan D, He ZY, Yao YL.  Carvedilol versus metoprolol for primary hypertension: a systematic review. Chinese Journal of Evidence-Based Medicine 2013; 13(8): 963-970

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Beta-blockers (carvedilol) in children with systemic ventricle systolic dysfunction - systematic review and meta-analysis

Background.Numerous prospective randomized clinical trials demonstrated favorable effect of beta-blockers in adults with chronic heart failure. However, effectiveness of beta blockers in pediatric patients with systemic ventricle systolic dysfunction was not recognized sufficiently. Limited number of pediatric patients might be the course of unrecognized carvediolol treatment benefit. Currently, no meta-analysis has examined the impact of carvedilol and conventional therapy on the clinical outcome in children with chronic heart failure due to impaired systemic ventricle systolic function. Materials and Methods.We have systematically searched the Medline/PubMed and Cochrane Library for the controlled clinical trials that examine carvedilol and standard treatment efficacy in pediatric patients with systemic ventricle systolic dysfunction. Mean differences for continuous variables, odds ratios for dichotomous outcomes, heterogeneity between studies and publication bias were calculated using Cochrane Review Manager (Rev Man 5.2). Results. Total of 8 prospective/observational studies met established criteria. Odds ratio for chronic heart failure related mortality/heart transplantation secondary to carvedilol was 0.57 (95% CI: 0.33-0.97, I(2) = 0%). Our analysis showed that carvedilol could prevent 1 death/ heart transplantation by treating 17 pediatric patients with impaired systemic ventricle systolic function. Conclusion. Meta-analysis demonstrated clinical outcome benefit of carvedilol in children with chronic heart failure.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

Meta-analysis of carvedilol versus beta 1 selective beta-blockers (atenolol, bisoprolol, metoprolol, and nebivolol).

Because carvedilol is a unique vasodilating β blocker (BB) exerting antioxidant activity and pleiotropic effects, it was theorized that it may confer more potent beneficial effects on cardiovascular mortality and morbidity in acute myocardial infarction (AMI) and heart failure (HF) settings. A systematic review and meta-analysis was performed of randomized, controlled, direct-comparison trials that included adults receiving atenolol, bisoprolol, metoprolol, nebivolol, or carvedilol to evaluate the effects of carvedilol compared to other BBs on mortality, cardiovascular events, and hospital readmissions in the setting of AMI or systolic HF. Compared to β(1)-selective BBs used in HF (8 trials, n = 4,563), carvedilol significantly reduced all-cause mortality (risk ratio 0.85, 95% confidence interval 0.78 to 0.93, p = 0.0006). In 3 trials of patients with AMI (n = 644), carvedilol significantly reduced all-cause mortality by 45% (fixed-effects model: risk ratio 0.55, 95% confidence interval 0.32 to 0.94, p = 0.03, random-effects model: risk ratio 0.56, 95% confidence interval 0.26 to 1.12, p = 0.10), with no reduction in non-fatal MI (risk ratio 0.61, 95% confidence interval 0.31 to 1.22, p = 0.16). In conclusion, carvedilol, as compared against atenolol, bisoprolol, metoprolol and nebivolol in randomized direct comparison trials, significantly reduced all-cause mortality in systolic HF patients. Additionally, carvedilol significantly reduced all-cause mortality compared with β(1)-selective BBs in AMI patients using the fixed-effects model but not using the random-effects model.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Meta-analysis comparing carvedilol versus metoprolol for the prevention of postoperative atrial fibrillation following coronary artery bypass grafting

A systematic review and meta-analysis was performed to evaluate the effects of carvedilol versus metoprolol on the incidence of postoperative atrial fibrillation in patients undergoing coronary artery bypass grafting in randomized controlled trials. Ovid MEDLINE, PubMed, CENTRAL, and Excepta Medica (EMBASE) were searched up to March 2013 for suitable randomized controlled trials. Data were pooled using random-effects model for pairwise analyses. A total of 4 trials with 601 patients were included in this analysis. Pairwise analyses showed that compared with metoprolol, carvedilol significantly reduced the incidence of postoperative atrial fibrillation (odds ratio 0.50, 95% confidence interval 0.32 to 0.80). In conclusion, compared with metoprolol, carvedilol significantly reduces the incidence of postoperative atrial fibrillation in patients undergoing coronary artery bypass grafting.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

Hemodynamic effect of carvedilol vs. propranolol in cirrhotic patients: systematic review and meta-analysis

BACKGROUND: Carvedilol appears to be more effective than propranolol in the treatment of portal hypertension in cirrhotic patients. Aim. To compare the effects of carvedilol vs. propranolol on systemic and splanchnic haemodynamics and to evaluate the adverse events associated with these treatments.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

Carvedilol for prevention of atrial fibrillation after cardiac surgery: a meta-analysis

BACKGROUND: Postoperative atrial fibrillation (POAF) remains the most common complication after cardiac surgery. Current guidelines recommend β-blockers to prevent POAF. Carvedilol is a non-selective β-adrenergic blocker with anti-inflammatory, antioxidant, and multiple cationic channel blocking properties. These unique properties of carvedilol have generated interest in its use as a prophylaxis for POAF.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

Systematic review with meta-analysis: the haemodynamic effects of carvedilol compared with propranolol for portal hypertension in cirrhosis

BACKGROUND: Propranolol is recommended for prophylaxis of variceal bleeding in cirrhosis. Carvedilol is a nonselective beta-blocker with a mild anti-alfa-1-adrenergic activity. Several studies have compared carvedilol and propranolol, yielding inconsistent results.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

Impact of carvedilol on the serum lipid profile

This review concluded that β1-selective antagonists worsened the lipid profile compared to carvedilol and that it was unclear whether carvedilol independently made an improvement or had a neutral effect. The review had several methodological flaws and the authors' conclusions are not likely to be reliable.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2008

Comparing Beta Blockers

How do beta blockers compare in hypertension?

PubMed Clinical Q&A [Internet] - National Center for Biotechnology Information (US).

Version: October 1, 2010

Drug Class Review: Agents for Overactive Bladder: Final Report Update 4 [Internet]

Overactive bladder is defined by the International Continence Society as a syndrome of urinary frequency and urgency, with or without urge incontinence, appearing in the absence of local pathological factors. Treatment of overactive bladder syndrome first requires a clear diagnosis. In patients with incontinence, multiple forms can be present and it is important to determine which form is dominant. Non-pharmacologic, non-surgical treatment consists of behavioral training (prompted voiding, bladder training, pelvic muscle rehabilitation), transcutaneous electrical nerve stimulation, catheterization, and use of absorbent pads. Pharmacologic treatment for overactive bladder syndrome includes darifenacin, flavoxate hydrochloride, hyoscyamine, oxybutynin chloride, tolterodine tartrate, trospium chloride, scopolamine transdermal, and solifenacin succinate. The purpose of this systematic review is to compare the benefits and harms of drugs used to treat overactive bladder syndrome.

Drug Class Reviews - Oregon Health & Science University.

Version: March 2009
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Evidence for the Reaffirmation of the U.S. Preventive Services Task Force Recommendation on Screening for High Blood Pressure [Internet]

High blood pressure is common, and screening is a well-established evidence-based standard of current medical practice.

Evidence Syntheses - Agency for Healthcare Research and Quality (US).

Version: December 2007
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Treatment of Atrial Fibrillation [Internet]

There are two generally accepted strategies for managing atrial fibrillation (AF): rate control and rhythm control. However, within each strategic approach there are a large number of potential pharmacological and nonpharmacological therapies, and the comparative safety and effectiveness of these therapies—both within and between strategies—are uncertain.

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: June 2013
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Angiotensin-Converting Enzyme Inhibitors (ACEIs), Angiotensin II Receptor Antagonists (ARBs), and Direct Renin Inhibitors for Treating Essential Hypertension: An Update [Internet]

A 2007 comparative effectiveness review (CER) evaluated the long-term benefits and harms of angiotensin-converting enzyme inhibitors (ACEIs) versus angiotensin II receptor blockers/antagonists (ARBs) for treating essential hypertension in adults. Since then, significant additional research has been published comparing these agents, and direct renin inhibitors (DRIs) have been introduced to the market. We sought to update 2007 CER on ACEIs versus ARBs and expand this to include comparisons with DRIs.

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: June 2011
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Dementia: A NICE-SCIE Guideline on Supporting People With Dementia and Their Carers in Health and Social Care

This guideline has been developed to advise on supporting people with dementia and their carers in health and social care. The guideline recommendations have been developed by a multidisciplinary team of health and social care professionals, a person with dementia, carers and guideline methodologists after careful consideration of the best available evidence. It is intended that the guideline will be useful to practitioners and service commissioners in providing and planning high-quality care for those with dementia while also emphasising the importance of the experience of care for people with dementia and carers.

NICE Clinical Guidelines - National Collaborating Centre for Mental Health (UK).

Version: 2007
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Drug Class Review: Direct Renin Inhibitors, Angiotensin Converting Enzyme Inhibitors, and Angiotensin II Receptor Blockers: Final Report [Internet]

The renin-angiotensin system is a complex biologic system between the heart, brain, blood vessels, and kidneys that leads to the production of biologically active agents, including angiotensin I and II and aldosterone, which act together to impact a variety of bodily functions including blood vessel tone, sodium balance, and glomerular filtration pressure. The multiple and varied effects of these agents allows the renin-angiotensin system to play a wide role in the pathology of hypertension, cardiovascular health, and renal function. Our ability to begin to intervene upon the complex cycle of hormone and other biochemical agent production within the renin-angiotensin system began with the advent of the first orally active ACE-I (angiotensin converting enzyme inhibitor), captopril, in 1981. AIIRAs (angiotensin II receptor blockers) were developed as an alternative to ACE-I, and block the interaction between angiotensin II and the angiotensin receptor. Losartan, the first commercially available AIIRA, was approved for clinical use in 1995. The goal of this report is to compare the effectiveness and harms between aliskiren and placebo and between AIIRAs and ACEIs in the treatment of diagnosed coronary heart disease, hypertension, left ventricular dysfunction, heart failure, nondiabetic chronic kidney disease, or diabetic nephropathy.

Drug Class Reviews - Oregon Health & Science University.

Version: January 2010
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Alpha and beta dual receptor blockers for treatment of high blood pressure

Alpha and beta dual receptor blockers are a subclass of beta blockers which are commonly used to treat high blood pressure (BP). Drugs in this class include carvedilol (Coreg), labetalol (Trandate) and dilevalol (Unicard). We searched for and found all the relevant studies to examine how well this class of drugs lowered blood pressure.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Pharmacological interventions for treating heart failure in patients with Chagas cardiomyopathy

Named in honor of the Brazilian physician Carlos Chagas, Chagas disease is caused by the Trypanosoma cruzi parasite which needs humans for the start of its life cycle. It is common in Latin and Central America and leads to Chagas cardiomyopathy (heart muscle disease), and is an important cause of heart failure. The number of people infected with Chagas disease has been estimated to be about 10 to 12 million worldwide, and around 20% to 30% of individuals infected with Trypanosoma cruzi will develop symptomatic heart disease at some point during their lives.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Drug Class Review: Beta Adrenergic Blockers: Final Report Update 4 [Internet]

Beta blockers inhibit the chronotropic, inotropic, and vasoconstrictor responses to the catecholamines, epinephrine, and norepinephrine. Beta blockers differ in their duration of effect (3 hours to 22 hours), the types of beta receptors they block (β1-selective or β1/β2-nonselective), whether they are simultaneously capable of exerting low level heart rate increases (intrinsic sympathomimetic activity [ISA]), and in whether they provide additional blood vessel dilation effects by also blocking alpha-1 receptors. All beta blockers are approved for the treatment of hypertension. Other US Food and Drug Administration-approved uses are specific to each beta blocker and include stable and unstable angina, atrial arrhythmias, bleeding esophageal varices, coronary artery disease, asymptomatic and symptomatic heart failure, migraine, and secondary prevention of post-myocardial infarction. The objective of this review was to evaluate the comparative effectiveness and harms of beta blockers in adult patients with hypertension, angina, coronary artery bypass graft, recent myocardial infarction, heart failure, atrial arrhythmia, migraine or bleeding esophageal varices.

Drug Class Reviews - Oregon Health & Science University.

Version: July 2009
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Drugs to prevent heart damage in cancer patients receiving anthracyclines

Anthracyclines are among the most effective chemotherapy treatments available for various types of cancer. However, there is a risk of damage to the heart (cardiotoxicity) depending on the cumulative dose. Certain drugs might prevent this damage, but for many of these drugs, the review authors found no high quality evidence about whether they were effective in protecting the heart and they were unable to draw conclusions. For dexrazoxane, the review authors found 10 studies enrolling over 1600 patients. These studies provided evidence that dexrazoxane prevented heart damage without interfering with the anti‐tumour effects of anthracycline treatment. Patients who got dexrazoxane with their anthracycline treatment had about one third of the risk of heart failure compared to patients who got anthracyclines without dexrazoxane. Dexrazoxane had no effect on survival. We can't be sure about whether it had any undesirable side effects.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Chronic Heart Failure: National Clinical Guideline for Diagnosis and Management in Primary and Secondary Care: Partial Update [Internet]

This guideline is a partial update of NICE Guideline No 5: Chronic Heart Failure - national clinical guideline for diagnosis and management in primary and secondary care (2003). The aim of the 2003 guideline was to offer best practice advice on the care of adult patients (aged 18 years or older) who have symptoms or a diagnosis of chronic heart failure. It defined the most effective combination of symptoms, signs and investigations required to establish a diagnosis of heart failure, and those which would influence therapy or provide important prognostic information. It also gave guidance on the treatment, monitoring and support of patients with heart failure.

NICE Clinical Guidelines - National Clinical Guideline Centre (UK).

Version: August 2010
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