Carvedilol - Coreg

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Carvedilol, the generic and less expensive form of Coreg, treats heart failure, stimulates a sluggish left ventricular pumping chamber compromised in the wake of a heart attack, and reduces elevated blood pressure.

At least 5 million adults suffer from heart failure – a condition indicating damage to the heart muscle from years of improperly controlled hypertension, narrowed coronary arteries, a previous heart attack or an improperly functioning aortic valve.

Symptoms include swelling of the feet and legs, chest pain, shortness of breath accentuated by lying flat, fatigue and bloating. Treatment includes a diuretic, an ACE inhibitor such as lisinopril and often carvedilol. Unfortunately even with treatment the 5 year survival remains about 50%.

Carvedilol treated patients with mild to moderate heart failure and an ejection fraction reduced to less than 35% benefit by a modest improvement in their overall statistics. This appears with respect to survival, cardiovascular death and sudden death. But prevention offers even greater success. The need for carvedilol and its mediocre results pales in comparison to a lifelong pattern of proper diet, exercise, weight control, cigarette avoidance and moderation in alcohol intake.

The Danish National Heart Failure Registry compared carvedilol to another popular drug metoprolol succinate and found no difference in outcome. Other studies also fail to find an advantage to carvedilol over metoprolol succinate or bisoprolol.

Similarly in those with a recent heart attack and low ejection fraction, carvedilol offers significant advantages when compared against an inactive placebo.

With regard to blood pressure control, most authorities consider carvedilol a second or third choice. While it certainly reduces both systolic and diastolic readings – the upper and lower numbers – carvedilol fails to prevent heart attacks, stroke or death in contrast to diuretics and ACE inhibitors.

As with heart failure, hypertension generally represents a lifestyle failure. Inattention to diet, excessive sodium intake, too much sugar, obesity, type 2 diabetes, the metabolic syndrome, lack of exercise, tobacco and alcohol ultimately lead to elevated blood pressure and compromised heart function. Simply believing a pill can correct decades of neglect woefully misjudges the prowess of modern medicine. Prevention always triumphs over treatment.

Exactly how carvedilol functions remains unclear. It combines beta blocker activity with alpha adrenergic receptor blockade. These activities slow the heart rate, decrease contractility and reduce blood pressure and peripheral vascular resistance against which the heart contracts. In the process it also prevents dilation of the vessels and blocks a reflex increase in the pulse rate. Which if any of these actually provide the benefits is currently not well defined.

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