Background. Cardiovascular autonomic neuropathy (CAN) is recognized as a significant health risk, correlating
with risk of heart disease, silent myocardial ischemia or sudden cardiac death. Beta-blockers are often prescribed
to minimize risk.
Objectives. In this second of two articles, the effects on parasympathetic and sympathetic activity of the alpha/
beta-adrenergic blocker, Carvedilol, are compared with those of the selective beta-adrenergic blocker, Metoprolol.
Methods: Retrospective, serial autonomic nervous system test data from 147 type 2 diabetes mellitus patients
from eight ambulatory clinics were analyzed. Patients were grouped according to whether a beta-blocker was
(1) introduced, (2) discontinued or (3) continued without adjustment. Group 3 served as the control.
Results. Introducing Carvedilol or Metoprolol decreased heart rate and blood pressure, and discontinuing them
had the opposite effect. Parasympathetic activity increased with introducing Carvedilol. Sympathetic activity
increased more after discontinuing Carvedilol, suggesting better sympathetic suppression. With ongoing treatment,
resting parasympathetic activity decreased with Metoprolol but increased with Carvedilol.
Conclusion. Carvedilol has a more profound effect on sympathovagal balance than Metoprolol. While both suppress
sympathetic activity, only Carvedilol increases parasympathetic activity. Increased parasympathetic activity
may underlie the lower mortality risk with Carvedilol.
Beta-blocker, Cardiovascular autonomic neuropathy, Heart rate variability, Patient outcomes, Respiratory analysis, Sympathovagal imbalance
Financial support: None.
Dr. Joe Colombo 240 South Eighth Street Philadelphia, PA, USA 19107 joe@ans-hrv.com
Trending Topic
Catheter ablation (CA) is an invasive adjunctive therapeutic option for atrial and ventricular arrhythmias, in uncontrolled cases, following optimal medical therapy.1,2 The validation of 3D mapping and its implementation into clinical usage has been a remarkable achievement in the field of complex ablation of scar-related ventricular tachycardia (VT) in the early 2000s.3 In the setting of atrial […]
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Welcome to a new issue of the European Journal of Arrhythmia & Electrophysiology. As the ongoing coronavirus disease 2019 (COVID-19) pandemic continues to provide unprecedented challenges for electrophysiologists and other healthcare providers who manage arrhythmias, we hope you find these topical ...
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Paroxysmal supraventricular tachycardia (PSVT) defines a group of cardiac arrhythmias where the underlying mechanism is dependent upon structures at or above the level of the atrioventricular node. The recent PRE-EMPT study retrospectively evaluated health records of over 4.2 million people in ...
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