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. B. Ramanathan, Suhail Ahmad, John H. Morledge, Elijah Saunders, Lawrence J. Lutz, Harold W. Schnaper, Morton Maxwell, Marcia P. Poland

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15 Scopus citations

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)
Pages (from-to)I58-I63
JournalThe American Journal of Cardiology
Volume63
Issue number19
DOIs
StatePublished - Jun 5 1989

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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