Among hemodialysis patients, treatment with carvedilol was associated with higher all-cause and cardiovascular mortality compared with metoprolol. The finding comes from a retrospective study published in the American Journal of Kidney Disease

For this study, researchers sought to investigate the impact of carvedilol vs metoprolol initiation on 1-year mortality among patients receiving hemodialysis. Using data from a large US dialysis organization, the researchers evaluated patients who initiated carvedilol or metoprolol from January 2007 to December 2012.  

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A total of 27,064 individuals were included in the study; 9558 (35.3%) and 17506 (64.7%) initiated carvedilol and metoprolol, respectively. Outcomes were assessed at a 1-year follow-up. Results showed that compared to metoprolol, those who initiated carvedilol had a greater all-cause (adjusted HR, 1.08; 95% CI,1.02-1.16) and cardiovascular mortality (adjusted HR, 1.18; 95% CI, 1.08-1.29). Additionally, carvedilol initiators had a higher rate of intradialytic hypotension (adjusted incidence rate ratio 1.10; 95% CI, 1.09-1.11). 

Among patients with hypertension, atrial fibrillation, heart failure, and recent myocardial infarction (the main cardiovascular indications for β-blocker treatment), similar associations were observed.

The authors concluded that, “one potential mechanism for these findings may be the increased occurrence of intradialytic hypotension after carvedilol (vs metoprolol) initiation.”

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