Clinical assessment of vasodilating carvedilol effects in patients with arterial hypertension and overweight/obesity: CAMELIA Study results

Aim. To compare the effects of two beta-adrenoblockers (BAB) – a generic carvedilol and metoprolol tartrate – on lipid profile, carbohydrate and purine metabolism parameters in patients with arterial hypertension (AH) and overweight or obesity (OW/O). Material and methods. The study included 320 patients, receiving carvedilol (n=160) or metoprolol tartrate (n=160) for 24 weeks. The effectiveness of antihypertensive therapy (AHT) was assessed by blood pressure (BP) dynamics at each visit and at the end of the study, comparing to baseline BP levels. Safety parameters included adverse event (AE) profile and biochemical parameter dynamics (lipid profile, glucose, creatinine (Cr), uric acid (UA), potassium (К+) and sodium (Na+)). Results. As early as at the first visits, a significant reduction in baseline levels of systolic and diastolic BP (SBP, DBP) was observed (р<0,0001). Both carvedilol and metoprolol therapy resulted in a significant reduction of heart rate (HR) and body mass index, BMI (by 0,39±0,07 kg/m2 (р<0,0001) at the end of the study). Carvedilol therapy was associated with improved lipid profile and glycemia parameters, while metoprolol was metabolically neutral. One of the new, positive findings was the absence of adverse effects of carvedilol-based AHT on purine metabolism. Conclusion. In patients with Stage 1-2 AH and OW/O, a good antihypertensive effect was observed for both medications studied. The latter, due to its additional vasodilating effect, demonstrated beneficial effects on AH-associated metabolic parameters. Therefore, carvedilol should be a BAB of choice in patients with AH and metabolic risk factors.

1. Berne C, Pollare T, Lithell H. Effects of antihypertensives on insulin sensitivity with special reference to ACE inhibitors. Diabetes Care 1991; 14 (Suppl. 4): 39-47.

2. Lind L, Berne C, Pollare T, et al. Metabolic effect of isradipin as monotherapy or in combination with pindolol during long term antihypertensive treatment. J Intern Med 1994; 236: 37-42.

3. Rossner S, Taylor CI, Byington RP, et al. Long term propranolol treatment and changes in body weight after myocardial infarction. Brit Med J 1990; 300: 901-3.

4. Rabkin SW. Mechanisms of action of adrenergic receptor blockers on lipids during antihypertensive drug treatment. J Clin Pharmacol 1993; 33: 286-91.

5. Lithell H, Pollare T, Vessby B. Metabolic effect of antihypertensive treatment with pindolol and propranolol in a double-blind cross-over study in hypertensive patients. Blood Pressure 1992; 92-101.

6. Jacob S, Rett K, Wiekmayr M, et al. Differential effect of chronic treatment with two betablocking agents on insulin sensitivity: the carvedilol- metoprolol study. J Hypertens 1996; 14: 489-94.

7. Lind L, Lithell H. Decreased peripheral blood flow in the pathogenesis of the metabolic syndrome comprising hypertension, hyperlipidemia and hyperinsulinemia. Am Heart J 1993; 125: 1494-7.

8. Bakris GL, Fonseca V, Katholi RE, et al. Metabolic effect of carvedilol vs metoprolol in patients with type 2 diabetes mellitus and hypertension. JAMA 2004; 292: 2227-36.

9. Марцевич С.Ю., Кутишенко Н.П. от имени рабочей группы исследования КАМЕЛИЯ. Исследование КАМЕЛИЯ: сравнение терапии, основанной на карведилоле или метопрололе у больных артериальной гипертензией и избыточной массой тела/ожирением. РФК 2008; 5: 34-8.

10. Марцевич С.Ю., Кутишенко Н.П., 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 гипертензией и избыточной массой тела/ ожирением. Первые результаты исследования КАМЕЛИЯ. РФК 2009; 1: 23-7.

11. Julius S, Jamerson K. Sympathetics, insulin resistens and coronary risk in hypertension: the “chicken-and-egg” question. J Hypertens 1994; 12: 495-502.

12. Lembo J, Vecchione C, Laccarino G, et al. The crosstalk between insulin and the sympathetic nervous system: possible implications in the pathogenesis of essential hypertension. Blood Pressure 1996; 51(Suppl.1): 38-42.

13. Lysko PG, Webb SL, Gu IL, et al. A comparison of carvedilol and metoprolol antioxidant activities in vitro. J Cardiovasc Pharmacol 2000; 36(2): 277-81.

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

15. Shultze GE, Sabin GV, Janitzki J, et al. Treatment of essential hypertension with carvedilol. Perfusion 2003; 16: 424-9.

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

17. Бамбышева Е.И., Толпыгина С.Н., Гуранда Д.Ф., Колтунов И.Е. Клиническая и фармакокинетическая эквивалентность оригинального и дженерического препарата карведилола у больных артериальной гипертензией 1-2 степени. РФК 2008; 3: 39-44.