COMPARISON OF THE METABOLIC EFFECTS OF CARVEDILOL AND METОPROLOL IN HYPERTENSIVE PATIENTS WITH OVERWEIGHT AND OBESITY. THE CAMELLIA TRIAL

Aim. To compare two therapies based on carvedilol or metoprolol in hypertensive patients with overweight and obesity.

Material and methods. 320 patients with arterial hypertension (1-2 degree) were involved in the study. 160 patients received carvedilol and 160 patients – metoprolol. Both randomized groups were comparable on the main clinical characteristics.

Results. By the end of the study both systolic and diastolic blood pressure (SBP, DBP) reduced in both groups р<0,0001. There were not differences of antihypertensive effect between investigated drugs (р=0,88 for SBP and р=0,61 for DBP). By the end of the study body mass index decreased by 0,52±0,10 kg/m2 (р<0,0001) in carvedilol group and by 0,26±0,10kg/m2 (р<0,01) in metoprolol group. Carvedilol in comparison with metoprolol had more positive effects on glucose (р<0,01) and lipid blood levels. By the end of the study urine acid blood level reduction was observed in carvedilol group (-16,6 μmol/l) while an increasing tendency - in metoprolol group. Carvedilol did not have negative effect on serum potassium and creatinine levels. Adverse effects rate was 6,3% in carvedilol group and 3,8% - in metoprolol group.

Conclusion. The results of open, randomized CAMELLIA trial confirmed antihypertensive effect and good tolerability of carvedilol in common clinical practice as well as demonstrated some its advantages in patients with metabolic syndrome. Carvedilol has positive metabolic effects on lipid, glucose and uric acid levels. Carvedilol therapy is more preferable in patients with arterial hypertension and metabolic risk factors.

1. Mancia G, De Backer G, Dominiczak A, et al.; Management of Arterial Hypertension of the European Society of Hypertension; European Society of Cardiology. 2007 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2007;25:1105-87.

2. Houf-Zachariou U, Widmann L, Zülsdorf B, et al A double-blind comparison of the effects of carvedilol and captopril on serum lipid concentrations in patients with mild to moderate essential hypertension and dyslipidemia. Eur J Clin Pharmacol 1993;45:95-100.

3. Bakris G.L., Fonseca V., Katholi R.E., et al. Metabolic effects of carvedilol vs metoprolol in patients with type 2 diabetes mellitus and hypertension. JAMA 2004:292:2227–36.

4. Goto Y, Tamachi H, FusegawaY, et al: Effects of carvedilol on serum lipids in patients with essential hypertension. J Cardiovasc Pharmacol 1991;18 Suppl 4:S45-50.

5. Moser M. Clinical experience with carvedilol. J Hum Hypertens 1993; 7 Suppl 1: S16-S20.

6. Hall S, Prescott RI, Hallman RJ, et al A comparative study of carvedilol, slow release nifedipine, and atenolol in the managment of essential hypertension. J Cardiovasc Pharmacol 1991; 8 Suppl 4:S35-8.

7. Stienen U, Meyer-Sabellek W. Hemodynamic and metabolic effects of carvedilol: a meta-analysis approach. Clin Investig 1992; 70 Suppl 1: S65- 72.

8. Moser M, Frishman W. Results of therapy with carvedilol, a beta-blocker vasodilator with antioxidant properties, in hypertensive patients. Am J Hypertens. 1998;11(1 Pt 2):15S-22S.

9. Giugliano D, Acampora R, Marfella R, et al. Metabolic and cardiovascular effects of carvedilol and atenolol in non-insulin-dependent diabetes mellitus and hypertension. A randomized, controlled trial. Ann Inter Med 1997;126(12):955-9.

10. Jacob S, Rett K, Wicklmayer M, et al. Differential effect of chronic treatment with two beta-blocking agents on insulin sensitivity: the carvedilol – metoprolol study. J Hypertens 1996;14(4)489-94.

11. Марцевич С.Ю., Кутишенко Н.П. от имени рабочей группы исследования КАМЕЛИЯ. Исследование КАМЕЛИЯ: сравнение терапии, основанной на карведилоле или метопрололе, у больных артериальной гипертонией и избыточной массой тела/ожирением. Рациональная Фармакотерапия в Кардиологии 2008;(5):34-8.

12. Марцевич С.Ю., Кутишенко, Шилова Е.В., Деев А.Д., Шальнова С.А., Оганов Р.Г.от имени рабочей группы по проведению исследования КАМЕЛИЯ. Сравнение терапии, основанной на карведилоле или метопрололе, у больных артериальной гипертонией и избыточной массой тела/ожирением. Первые результаты исследования КАМЕЛИЯ. Рациональная Фармакотерапия в Кардиологии 2009;(1):23-7.

13. Красных Л.М., Савченко А.Ю., Раменская Г.В., Кукес В.Г. Определение относительной биодоступности и биоэквивалентности препаратов карведилола – Ведикардола и Дилатренда. Трудный пациент 2006;(10):15-7.

14. Бамбышева Е.И., Толпыгина С.Н., Гуранда Д.Ф., Колтунов И.Е. Клиническая и фармакокинетическая эквивалентность оригинального и дженерического препаратов карведилола у больных артериальной гипертонией 1-2 степени. Рациональная Фармакотерапия в Кардиологии 2008;(3):39-44.

15. Fajardo N, Deshaies Y. Long-term alfa1-adrenergic blockade attenuates dyslipidemia and hyperinsulinemia in the rat. J Cardiovasc Pharmacol 1998;32:913-9.