Differential effects of carvedilol and metoprolol on renal function in patients with heart failure

Abstract

Background: The aim of the present study was to verify the effects of /S-blockers on renal function in patients with heart failure (HF).&Methods and Results: A total of 40 patients with HF (New York Heart Association class, II-III) were enrolled, who had S-blocker therapy initiated with carvedilol (n=23) or metoprolol (n=17). The changes in renal and cardiac function were retrospectively analyzed over 16 weeks. The study population was divided into 2 groups according to the median baseline (65.9ml/min) of estimated glomerular fltration rate (eGFR) calculated by the Modifcation of Diet in Renal Disease formula. eGFR signifcantly decreased in the higher eGFR group (P=0.04), but did not in the lower eGFR group. Left ventricular ejection fraction signifcantly increased in both groups with lower eGFR (P=0.01) and higher eGFR (P<0.01). There was an interaction between plasma norepinephrine concentration and eGFR in terms of β-blocker treatment (P=0.02, ANOVA). eGFR signifcantly decreased in patients who received metoprolol (from 75.7±33.5 to 59.5±20.0ml·min- 1·1.73 m -2, P<0.01), but did not change in those who received carvedilol (from 67.1±27.7ml·min- 1·1.73 m -2 to 65.6±23.2ml·min- 1·1.73m -2).&Conclusions: β -Blockers preserved renal function in HF patients with lower baseline eGFR, but not in those with higher baseline eGFR. Carvedilol may be preferable to metoprolol to prevent the development of chronic kidney disease during β-blocker therapy for HF.