Carvedilol or Metoprolol European Trial (COMET) compared overall mortality in patients with heart failure, randomised to receive either carvedilol or metoprolol tartrate.t is important to note that in the COMET trial, carvedilol was compared with metoprolol tartrate. The MERIT-HF trial compared metoprolol succinate to placebo and it was found that metoprolol succinate reduced the mortality rate by 34% in patients with heart failure.
Carvedilol may be an option for patients initiating beta-blocker treatment for heart failure or patients in whom metoprolol is poorly tolerated. We present the results of the COMET trial and other research and discuss strategies for initiating carvedilol treatment. It is important to note that in the COMET trial, carvedilol was compared with metoprolol tartrate. The MERIT-HF trial compared metoprolol succinate to placebo and it was found that metoprolol succinate reduced the mortality rate by 34% in patients with heart failure. significantly more than metoprolol. (P = .001), and twice as many metoprolol patients than carvedilol patients had an HMG-CoA reductase inhibitor (statin) initiated or increased during the maintenance phase of the study (4.9% versus 2.4%; P = .04). No between-treatment differences were seen in either low-or high-density lipoprotein cholesterol levels. Endothelial function was also favorably affected by carvedilol because of decreased insulin resistance and/or oxidative stress, but not by metoprolol. Microalbuminuria, defined as a urinary albumin-to-creatinine ratio of 30 to 300 mg/g, was present in 19% of patients at baseline. Prospective crossover comparison of carvedilol and metoprolol in patients with chronic heart failure. Maack C, Elter T, Nickenig G, LaRosee K, Crivaro M, Staeblein Stäblein, A Wuttke, H Boehm. böhm m  1 Carvedilol may be an option if metoprolol succinate is poorly tolerated. 2  In patients with heart failure who have not previously used a beta-blocker, carvedilol may be considered as the first choice agent. 3  Strategies for initiating carvedilol are discussed in the following article. It is important to note that in the COMET trial, carvedilol was compared with metoprolol tartrate. The MERIT-HF trial compared metoprolol succinate to placebo and it was found that metoprolol succinate reduced the mortality rate by 34% in patients with heart failure. Poole-Wilson PA, Swedberg K, Cleland JGF, et al, for the COMET Investigators. Comparison of carvedilol and metoprolol on clinical outcomes in patients with chronic heart failure in the Carvedilol Or Metoprolol European Trial (COMET): a randomised controlled trial. Lancet. 2003;362:7-13. Poole-Wilson PA. Carvedilol or Metoprolol European Trial (COMET).  The rationale and design of the Glycemic Effects in Diabetes Mellitus: Carvedilol-Metoprolol Comparison in Hypertensives (GEMINI) trial. J Diab ComplIn press18 +Arauz-Pacheco C, Parrott MA, Raskin P. The treatment of hypertension in adult patients with diabetes. Diabetes Care. Interventions Participants were randomized to receive a 6.25- to 25-mg dose of carvedilol (n = 498) or 50- to 200-mg dose of metoprolol tartrate (n = 737), each twice daily. Open-label hydrochlorothiazide and a dihydropyridine calcium antagonist were added, if needed, to achieve blood pressure target. Comparing carvedilol and metoprolol: results of the COMET trial. The Carvedilol or Metoprolol European Trial (COMET) compared overall mortality in patients with heart failure, randomised to receive either carvedilol or metoprolol tartrate. It is important to note that in the COMET trial, carvedilol was compared with metoprolol tartrate. The MERIT-HF trial compared metoprolol succinate to placebo and it was found that metoprolol succinate reduced the mortality rate by 34% in patients with heart failure. The steeringcommittee selected 25 mg twice daily for carvedilol and 50mg twice daily for metoprolol to be used as target doses inCOMET to achieve a comparable degree of blockade in both groups. 21 The evidence suggested that adose ratio of 2 to 1 would achieve similar reductions inheart rate. Sudden death was the adjudicatedmode of death for 218 patients (14%) in the carvedilolgroup and in 262 (17%) patients in the metoprolol group—43% of all deaths in the carvedilol group and 44% in themetoprolol group. Each patient’s dose was titrated progressively from 6.25 mg of carvedilol twice daily and 50 mg of metoprolol twice daily to a maximum dose of 25 mg and 200 mg twice daily, respectively, at 1- to 2-week intervals toward target BP levels for a total of 2 to 7 weeks. Interventions Participants were randomized to receive a 6.25- to 25-mg dose of carvedilol (n = 498) or 50- to 200-mg dose of metoprolol tartrate (n = 737), each twice daily. Open-label hydrochlorothiazide and a dihydropyridine calcium antagonist were added, if needed, to achieve blood pressure target. Demographic analyses of the effects of carvedilol vs metoprolol on glycemic control and insulin sensitivity in patients with type 2 diabetes and hypertension in the Glycemic Effects in Diabetes Mellitus: Carvedilol-Metoprolol Comparison in Hypertensi J Cardiometab Syndr 2008;3(4):211-7. Interventions Participants were randomized to receive a 6.25- to 25-mg dose of carvedilol (n = 498) or 50- to 200-mg dose of metoprolol tartrate (n = 737), each twice daily. Open-label hydrochlorothiazide and a dihydropyridine calcium antagonist were added, if needed, to achieve blood pressure target.
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patient reviews comparing carvedilol and metoprolol