Why is Carvedilol (and other beta blockers) used in heart failure?
In the mid 90′s, the thinking of the medical community was that beta blockers were bad for heart failure because they reduce both the heart rate and myocardial contractility. However, shortly after ACE inhibitors were introduced, it was quickly realized that when in heart failure, one has a major activation of the sympathetic nervous system, which then activates the rennin-angiotensin system, which then activates the sympathetic nervous system again. This cycle leads to extreme salt and water retention and actually makes your heart performance worst. In other words, heart failure brings about more heart failure. Beta blockers like Carvedilol, and especially when used with ACE inhibitors, actually limit or all together block this dangerous cycle. There is also research data to come to the conclusion that they have a rhythm stabilizing effect as well.
Currently, there are 4 beta blocker drugs used to treat heart failure:
Metoprolol has fallen out of favor, arguably because of the COMET trials. Carvedilol however is a nonselective beta blocker that also ‘vasodilates peripherally’, which in theory reduces some more common beta blocker side effects. In other words, it is commonly respected that Carvedilol has the least side effects of all beta blocker options for heart failure.
- Safer in diabetics (less lipid side effects)
- Documented studies showing better outcomes including increased survival, less hospitalizations, and less side-effects than placebo
- Is a generic, medication so it is cheaper (see the ad above for a link to buy carvedilol up to 47% off)
- It has been on the market for a number of years and is stable
- Does not easily accumulate in the body over time
- Has a very wide dosage range (see the article Carvedilol Dosage)