Influence of beta2 agonism and beta1 and beta2 antagonism on adverse effects and plasma lipoproteins

Results of a multicenter comparison of dilevalol and metoprolol

Barry J. Materson, Nicholas D. Vlachakis, Stephen P. Glasser, Charles Lucas, K Ramanathan, Suhail Ahmad, John H. Morledge, Elijah Saunders, Lawrence J. Lutz, Harold W. Schnaper, Morton Maxwell, Marcia P. Poland

Research output: Contribution to journalArticle

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Abstract

Dilevalol combines vasodilation due to selective β2 agonism and nonselective β antagonism. We studied 311 patients randomized to dilevalol and 138 to metoprolol in a multicenter trial. After a 4-week placebo washout, dilevalol was titrated from 200 to 1,600 mg once daily and metoprolol from 100 to 400 mg to a goal supine diastolic blood pressure < 90 and ≥10 mm Hg decrease from baseline. Responders were followed for 1 year. The average age of patients was 51 years; 72% were men and 54% were white. Both drugs reduced blood pressure effectively to a similar level. Fewer patients discontinued dilevalol than did those taking metoprolol (9 vs 16%; p < 0.03). More metoprolol-treated patients withdrew because of depression (6 vs < 1%; p = 0.03) and impotence (5 vs < 1%; p = 0.03). Lipoprotein levels before and after treatment were measured in 99 patients treated for 53.5 weeks with dilevalol (mean dose 438 mg). Dilevalol increased high-density lipoprotein (HDL) cholesterol by 2.5 mg/dl to 47.2 (p = 0.05), reduced lowdensity lipoprotein (LDL) cholesterol by 2.5 mg/dl, increased HDL/LDL by 0.03, and decreased total cholesterol/HDL cholesterol by 0.18. Triglycerides increased by 21 mg/dl (p = 0.06). In patients with an initial HDL cholesterol < 35 mg/dl, dilevalol increased it by 9 mg/dl. In patients treated with metoprolol, the only significant change (p = 0.02) was a 41.9-mg/dl increase in triglyceride levels. It is concluded from this trial that dilevalol is an effective antihypertensive agent, may have a more favorable side-effect profile than metoprolol and may increase HDL cholesterol in hypertensive patients with low HDL cholesterol.

Original languageEnglish (US)
JournalThe American Journal of Cardiology
Volume63
Issue number19
DOIs
StatePublished - Jun 5 1989

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Labetalol
Metoprolol
Lipoproteins
HDL Cholesterol
Blood Pressure
Triglycerides
Erectile Dysfunction
HDL Lipoproteins
Vasodilation
LDL Cholesterol
Antihypertensive Agents
Multicenter Studies
Cholesterol
Placebos
Depression

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Influence of beta2 agonism and beta1 and beta2 antagonism on adverse effects and plasma lipoproteins : Results of a multicenter comparison of dilevalol and metoprolol. / Materson, Barry J.; Vlachakis, Nicholas D.; Glasser, Stephen P.; Lucas, Charles; Ramanathan, K; Ahmad, Suhail; Morledge, John H.; Saunders, Elijah; Lutz, Lawrence J.; Schnaper, Harold W.; Maxwell, Morton; Poland, Marcia P.

In: The American Journal of Cardiology, Vol. 63, No. 19, 05.06.1989.

Research output: Contribution to journalArticle

Materson, Barry J. ; Vlachakis, Nicholas D. ; Glasser, Stephen P. ; Lucas, Charles ; Ramanathan, K ; Ahmad, Suhail ; Morledge, John H. ; Saunders, Elijah ; Lutz, Lawrence J. ; Schnaper, Harold W. ; Maxwell, Morton ; Poland, Marcia P. / Influence of beta2 agonism and beta1 and beta2 antagonism on adverse effects and plasma lipoproteins : Results of a multicenter comparison of dilevalol and metoprolol. In: The American Journal of Cardiology. 1989 ; Vol. 63, No. 19.
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abstract = "Dilevalol combines vasodilation due to selective β2 agonism and nonselective β antagonism. We studied 311 patients randomized to dilevalol and 138 to metoprolol in a multicenter trial. After a 4-week placebo washout, dilevalol was titrated from 200 to 1,600 mg once daily and metoprolol from 100 to 400 mg to a goal supine diastolic blood pressure < 90 and ≥10 mm Hg decrease from baseline. Responders were followed for 1 year. The average age of patients was 51 years; 72{\%} were men and 54{\%} were white. Both drugs reduced blood pressure effectively to a similar level. Fewer patients discontinued dilevalol than did those taking metoprolol (9 vs 16{\%}; p < 0.03). More metoprolol-treated patients withdrew because of depression (6 vs < 1{\%}; p = 0.03) and impotence (5 vs < 1{\%}; p = 0.03). Lipoprotein levels before and after treatment were measured in 99 patients treated for 53.5 weeks with dilevalol (mean dose 438 mg). Dilevalol increased high-density lipoprotein (HDL) cholesterol by 2.5 mg/dl to 47.2 (p = 0.05), reduced lowdensity lipoprotein (LDL) cholesterol by 2.5 mg/dl, increased HDL/LDL by 0.03, and decreased total cholesterol/HDL cholesterol by 0.18. Triglycerides increased by 21 mg/dl (p = 0.06). In patients with an initial HDL cholesterol < 35 mg/dl, dilevalol increased it by 9 mg/dl. In patients treated with metoprolol, the only significant change (p = 0.02) was a 41.9-mg/dl increase in triglyceride levels. It is concluded from this trial that dilevalol is an effective antihypertensive agent, may have a more favorable side-effect profile than metoprolol and may increase HDL cholesterol in hypertensive patients with low HDL cholesterol.",
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AU - Vlachakis, Nicholas D.

AU - Glasser, Stephen P.

AU - Lucas, Charles

AU - Ramanathan, K

AU - Ahmad, Suhail

AU - Morledge, John H.

AU - Saunders, Elijah

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