Influence of beta 2 agonism and beta 1 and beta 2 antagonism on adverse effects and plasma lipoproteins: results of a multicenter comparison of dilevalol and metoprolol.

Academic Article

Abstract

  • Dilevalol combines vasodilation due to selective beta 2 agonism and nonselective beta antagonism. We studied 311 patients randomized to dilevalol and 138 to metoprolol in a multicenter trial. After a 4-week placebo washout, dilevalol was titrated from 200 to 1,600 mg once daily and metoprolol from 100 to 400 mg to a goal supine diastolic blood pressure less than 90 and greater than or equal to 10 mm Hg decrease from baseline. Responders were followed for 1 year. The average age of patients was 51 years; 72% were men and 54% were white. Both drugs reduced blood pressure effectively to a similar level. Fewer patients discontinued dilevalol than did those taking metoprolol (9 vs 16%; p less than 0.03). More metoprolol-treated patients withdrew because of depression (6 vs less than 1%; p = 0.03) and impotence (5 vs less than 1%; p = 0.03). Lipoprotein levels before and after treatment were measured in 99 patients treated for 53.5 weeks with dilevalol (mean dose 438 mg). Dilevalol increased high-density lipoprotein (HDL) cholesterol by 2.5 mg/dl to 47.2 (p = 0.05), reduced low-density lipoprotein (LDL) cholesterol by 2.5 mg/dl, increased HDL/LDL by 0.03, and decreased total cholesterol/HDL cholesterol by 0.18. Triglycerides increased by 21 mg/dl (p = 0.06). In patients with an initial HDL cholesterol less than 35 mg/dl, dilevalol increased it by 9 mg/dl. In patients treated with metoprolol, the only significant change (p = 0.02) was a 41.9-mg/dl increase in triglyceride levels.(ABSTRACT TRUNCATED AT 250 WORDS)
  • Published In

    Keywords

  • Adrenergic beta-Agonists, Adrenergic beta-Antagonists, Aged, Cholesterol, Coronary Disease, Double-Blind Method, Female, Heart Rate, Humans, Hydrochlorothiazide, Hypertension, Labetalol, Lipoproteins, Male, Metoprolol, Middle Aged, Multicenter Studies as Topic, Random Allocation, Risk Factors, Supination, Triglycerides
  • Pubmed Id

  • 24267211
  • Author List

  • Materson BJ; Vlachakis ND; Glasser SP; Lucas C; Ramanathan KB; Ahmad S; Morledge JH; Saunders E; Lutz LJ; Schnaper HW
  • Start Page

  • 58I
  • End Page

  • 63I
  • Volume

  • 63
  • Issue

  • 19