Influence of heart rate, blood pressure, and beta-blocker dose on outcome and the differences in outcome between carvedilol and metoprolol tartrate in patients with chronic heart failure: results from the COMET trial

AIMS: We studied the influence of heart rate (HR), systolic blood pressure (SBP), and beta-blocker dose on outcome in the 2599 out of 3029 patients in Carvedilol Or Metoprolol European Trial (COMET) who were alive and on study drug at 4 months after randomization (time of first visit on maintenance therapy). METHODS AND RESULTS: By multivariable analysis, baseline HR, baseline SBP, and their change after 4 months were not independently related to subsequent outcome. In a multivariable analysis including clinical variables, HR above and SBP below the median value achieved at 4 months predicted subsequent increased mortality [relative risk (RR) for HR>68 b.p.m. 1.333; 95% confidence intervals (CI) 1.152-1.542; P<0.0001 and RR for SBP>120 mmHg 0.78; 95% CI 0.671-0.907; P<0.0013]. Achieving target beta-blocker dose was associated with a better outcome (RR 0.779; 95% CI 0.662-0.916; P<0.0025). The superiority of carvedilol as compared to metoprolol tartrate was maintained in a multivariable model (RR 0.767; 95% CI 0.663-0.887; P=0.0004) and there was no interaction with HR, SBP, or beta-blocker dose. CONCLUSION: Beta-blocker dose, HR, and SBP achieved during beta-blocker therapy have independent prognostic value in heart failure. None of these factors influenced the beneficial effects of carvedilol when compared with metoprolol tartrate at the pre-defined target doses used in COMET.

MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin Kardiologi hsv//swe
MEDICAL AND HEALTH SCIENCES Clinical Medicine Cardiac and Cardiovascular Systems hsv//eng
Adrenergic beta-Antagonists/*administration & dosage
Blood Pressure/*physiology
Carbazoles/*administration & dosage
Chronic Disease
Dose-Response Relationship
Drug
Double-Blind Method
Female
Heart Failure
Congestive/*drug therapy/mortality/physiopathology
Heart Rate/*physiology
Humans
Male
Metoprolol/*administration & dosage
Middle Aged
Propanolamines/*administration & dosage
Treatment Outcome

Torp-Pedersen, C. (author)
Swedberg, Karl,1944Gothenburg University,Göteborgs universitet,Hjärt-kärlinstitutionen,Cardiovascular Institute(Swepub:gu)xsweka (author)
Cleland, J. G. (author)
Di Lenarda, A. (author)
Komajda, M. (author)
Remme, W. J. (author)
Lutiger, B. (author)
Scherhag, A. (author)
Lukas, M. A. (author)
Charlesworth, A. (author)
Poole-Wilson, P. A. (author)
Göteborgs universitetHjärt-kärlinstitutionen (creator_code:org_t)

In:European heart journal: Oxford University Press (OUP)26:21, s. 2259-680195-668X1522-9645

By the author/editor: Metra, M.; Torp-Pedersen, C ...; Swedberg, Karl, ...; Cleland, J. G.; Di Lenarda, A.; Komajda, M.; show more...; Remme, W. J.; Lutiger, B.; Scherhag, A.; Lukas, M. A.; Charlesworth, A.; Poole-Wilson, P. ...; show less...

About the subject

MEDICAL AND HEALTH SCIENCES: MEDICAL AND HEAL ...; and Clinical Medicin ...; and Cardiac and Card ...

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