Carvedilol (Coreg®) Reduces Albuminuria in Type 2 Diabetics

In hypertensive patients with type 2 diabetes, carvedilol reduces microalbuminuria to a greater extent than does metoprolol.

Dr. Bakris from Rush University Medical Center, Chicago, Illinois stated that, "Unlike conventional beta-blockers that have been shown not to have consistent effects on microalbuminuria, carvedilol has more favorable effects, effects that can’t be solely attributed to either blood pressure reduction or alpha-blocking effects."

They compared the effects of carvedilol and metoprolol on changes in albuminuria and blood pressure in the presence of renin-angiotensin system blockade in 1235 patients with type 2 diabetes and hypertension.

Blood pressure changes did not differ between the carvedilol and metoprolol groups, the authors report, but the magnitude of blood pressure lowering was less in those with microalbuminuria at screening compared with those with normoalbuminuria.

Treatment with carvedilol was associated with a 16% relative reduction in albuminuria at the end of the trial, compared with metoprolol treatment, the report indicates, and fewer patients treated with carvedilol (6.6%) progressed from normoalbuminuria to microalbuminuria than did patients treated with metoprolol (11.1%).

There was no correlation between changes in urine albumin:creatinine ratio and systolic blood pressure reduction, the results indicate.

"These observations, if confirmed in properly powered prospective studies, hold the promise that some beta-blockers may further reduce the risk of adverse metabolic effects and may further reduce cardiovascular risk to greater extent than commonly used beta-blocker agents," the researchers conclude.

"These data suggest that not all beta-blockers are the same with regard to their effects on cardiovascular risk factors," they add. "A prospective study is needed to assess whether this effect on albuminuria will translate to lower cardiovascular events."

"Since microalbuminuria is a cardiovascular risk marker, anything that can reduce it should be used," Dr. Bakris said. "Since carvedilol in concert with an ACE inhibitor or ARB does this, it should be given preference, if not cost prohibitive."

Hypertension 2005;46:1309-1315.

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