23 June 2010 - Extended-release carvedilol differs to extended-release metoprolol in its effect on triglyceride levels, but has a similar impact on high-density lipoprotein (HDL) cholesterol in hypertensive patients without dyslipidemia, trial findings suggest. Triglyceride levels remained unchanged with the former beta blocker but increased with the latter, results from the Extended-Release Carvedilol Lipid Trial indicate. 

Although beta-blockers are effective antihypertensive agents, they are generally perceived to adversely affect dyslipidemia and decrease insulin sensitivity in hypertensive individuals, Gregg Fonarow, MD (University of California at Los Angeles, USA) and colleagues explain in the Journal of the American Society of Hypertension. 

To investigators assigned 568 random hypertensive patients without diabetes or required lipid-lowering therapy to receive extended-release carvedilol 20-80 mg or extended-release metoprolol 50-200 mg once daily titrated to a target blood pressure of < 140/90 mmHg. The primary endpoint examined whether extended-release carvedilol had a superior effect to extended-release metoprolol on lipid profile, measured by the mean percent change from baseline in fasting HDL cholesterol and triglycerides after 6 months of therapy. Triglyceride levels did not significantly change with extended-release carvedilol, with a median increase from 167.26 mg/dl (1.89 mmol/l) at baseline to 169.03 mg/dl (1.91 mmol/l) at the end of treatment. 

In contrast, triglyceride levels significantly increased with extended-release metoprolol, from a median of 169.91 mg/dl (1.92 mmol/l) to 188.50 mg/dl (2.13 mmol), respectively. The difference in median percent change in triglycerides between the two groups was a significant 8.03%. 

Geometric mean HDL levels significantly decreased with both treatments, but the difference in mean percent change was not statistically significant. 

There was also a significant decrease in insulin and c-peptide levels with extended-release carvedilol, compared with extended-release metoprolol, although blood pressure changes were similar with both treatments. 

The investigators conclude that their results "may be useful in guiding antihypertensive treatment options."