Carvedilol or Metoprolol European Trial (COMET) 1511 patients receive 40 carvedilol (25 mg BID); 1518 receive metoprolol (50 30 mg BID) ● NYHA II-IV;EF<.35;ACE-I+ 20 ▣Car diuretic (if tolerated) 口Met Mean 58 months in trial 10 Carvedilol reduced all- cause (HR.83)and CV(.80) All cv mortality relative to meto Deaths Deaths Poole-Wilson.Lancet 2003;362:7-13
Carvedilol Carvedilol or Metoprolol Metoprolol European European Trial ( Trial (COMET) 1511 patients receive carvedilol (25 mg BID); 1518 receive metoprolol (50 mg BID) NYHA II-IV; EF<.35; ACE-I + diuretic (if tolerated) Mean 58 months in trial Carvedilol reduced allcause (HR .83) and CV (.80) mortality relative to meto 0 10 20 30 40 All CV Car Met % Poole-Wilson. Lancet 2003;362:7-13 Deaths Deaths
Application attention: 1、选择合适的制剂 Selective B-R blocker:Metoprolol,Bisoprolol No selective B and a-R blocker:Carvedilol 2、应用恰当的剂量 起始量必须极小。 Metoprolol 12.5mg/d;Bisoprolol 1.25mg/d;Carvedilol 3.125mg/d每24周剂量加倍，达最大耐受量或目标剂 量后长期维持
Application attention: Application attention: 1、选择合适的制剂 Selective β 1-R blocker: Metoprolol、Bisoprolol No selective β and α 1-R blocker: Carvedilol 2、应用恰当的剂量 起始量必须极小。 Metoprolol 12.5mg/d; Bisoprolol 1.25mg/d;Carvedilol 3.125mg/d 每 2 ～ 4周剂量加倍，达最大耐受量或目标剂 量后长期维持
Application attention: 3、合用利尿药、ACEI、地高辛。 4、密切观察可能出现的不良反应： 血流动力学恶化，心动过缓，低血压。 5、禁忌症： 支气管哮喘、心动过缓（心率<60 次/分)、Ⅱ度以上房室传导阻滞、低血
3、合用利尿药、ACEI、地高辛。 4、密切观察可能出现的不良反应： 血流动力学恶化，心动过缓，低血压。 5、禁忌症： 支气管哮喘、心动过缓（心率< 60 次/分）、Ⅱ度以上房室传导阻滞、低血 压。 Application attention: Application attention: