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-Blockers in Congestive Heart Failure: Is There a Difference Between Classes?

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

I read with great interest the article by Bonet et al¹ regarding the benefits of vasodilating and nonvasodilating agents. Clearly, it would be useful clinically to know if vasodilating -blockers such as carvedilol are more effective than less expensive, nonvasodilating -blockers such as metoprolol.

The authors draw the conclusion that vasodilating -blockers had a greater effect on overall mortality than nonvasodilating -blockers. That conclusion is a matter of statistical interpretation and not wholly supported by the authors.

Clearly, the combined -blocker groups show a significant reduction in mortality with an absolute risk reduction of 5.9% (number needed to treat of 17, as cited by the authors). In the subgroups, they appear to base the advantage of vasodilating -blockers on an overall mortality rate of 4.5%, compared with an overall mortality rate of 14.1% in the nonvasodilating -blocker studies. Thus, it appears that the vasodilating -blockers are associated with an absolute . . . [Full Text of this Article]

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-Adrenergic Blocking Agents in Heart Failure: Benefits of Vasodilating and Nonvasodilating Agents According to Patients' Characteristics: A Meta-analysis of Clinical Trials
Sara Bonet, Antònia Agustí, Josep M. Arnau, Xavier Vidal, Eduard Diogène, Enrique Galve, and Joan-Ramon Laporte
Arch Intern Med. 2000;160(5):621-627.
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