Carvedilol , within the recommended dose range , did not show a significant dose response effect for SBP or DBP .
Carvedilol had little or no effect on pulse pressure ( -1 mm Hg ) and did not change BP variability .
Due to the larger sample size from the two unpublished studies , carvedilol provided a better estimate of BP lowering effect than labetalol .
Doses higher than the recommended starting dose did not provide additional BP reduction .
Higher doses of dual receptor blockers caused more bradycardia than lower doses .
Based on indirect comparison with other classes of drugs , the blood pressure lowering effect of dual alpha- and beta-receptor blockers is less than non-selective , beta1 selective and partial agonist beta blockers , as well as thiazides and drugs inhibiting the renin angiotensin system .
Dual blockers also had little or no effect on reducing pulse pressure , which is similar to the other beta-blocker classes , but less than the average reduction of pulse pressure seen with thiazides and drugs inhibiting the renin angiotensin system .
Patients taking dual receptor blockers  were not more likely to withdraw from the study compared to patients taking placebo
BACKGROUND Drugs with combined alpha and beta blocking activity are commonly prescribed to treat hypertension .
However , the blood pressure ( BP ) lowering efficacy of this class of beta blockers has not been systematic ally review ed and quantified .
OBJECTIVES To quantify the dose-related effects of various types of dual alpha and beta adrenergic receptor blockers ( dual receptor blockers ) on systolic and diastolic blood pressure versus placebo in patients with primary hypertension .
Controlled-release carvedilol in the treatment of essential hypertension.
Carvedilol is a beta1- , beta2- , and alpha1-adrenergic blocker that is approved for the treatment of hypertension . A new once-daily , controlled-release ( CR ) formulation of carvedilol has been shown to be effective in a double-blind , r and omized , multicenter , placebo-controlled , parallel-group study . In this article , we summarize the primary results of , and present additional analyses from , that trial . A total of 338 patients with essential hypertension ( sitting diastolic blood pressure [ DBP ] > /=90 and < /=109 mm Hg ) were r and omized to receive carvedilol CR 20 , 40 , or 80 mg or placebo for 6 weeks . The primary objective was to compare the effects of the 3 carvedilol CR doses with placebo on 24-hour mean blood pressure using ambulatory blood pressure monitoring ( ABPM ) . Mean DBP and systolic BP ( SBP ) at the drug trough ( 20 - 24 hour ) blood levels for carvedilol CR and comparison of DBP and SBP at the drug peak ( 3 - 7 hour ) blood levels for each dose of carvedilol CR and placebo were investigated . The effects of carvedilol CR on heart rate and pulse pressure were also examined . Once-daily administration of carvedilol CR , alone or in combination with other agents , produced clinical ly and statistically significant reductions compared with placebo for both DBP and SBP after 6 weeks of treatment for the following parameters : trough blood pressure by office cuff or ABPM measurements , peak blood pressure by ABPM , and 24-hour mean blood pressure by ABPM . Placebo-corrected trough-to-peak ratios for DBP were > 0.6 for each carvedilol CR dose . Heart rate and pulse pressure were each significantly reduced compared with placebo for each carvedilol CR dose . We conclude that carvedilol CR is a very effective antihypertensive agent with clear dose-related peak blood pressure reduction and continuous 24-hour control
Carvedilol , within the recommended dose range , did not show a significant dose response effect for SBP or DBP .
Carvedilol had little or no effect on pulse pressure ( -1 mm Hg ) and did not change BP variability .
Due to the larger sample size from the two unpublished studies , carvedilol provided a better estimate of BP lowering effect than labetalol .
Doses higher than the recommended starting dose did not provide additional BP reduction .
Higher doses of dual receptor blockers caused more bradycardia than lower doses .
Based on indirect comparison with other classes of drugs , the blood pressure lowering effect of dual alpha- and beta-receptor blockers is less than non-selective , beta1 selective and partial agonist beta blockers , as well as thiazides and drugs inhibiting the renin angiotensin system .
Dual blockers also had little or no effect on reducing pulse pressure , which is similar to the other beta-blocker classes , but less than the average reduction of pulse pressure seen with thiazides and drugs inhibiting the renin angiotensin system .
Patients taking dual receptor blockers  were not more likely to withdraw from the study compared to patients taking placebo
BACKGROUND Drugs with combined alpha and beta blocking activity are commonly prescribed to treat hypertension .
However , the blood pressure ( BP ) lowering efficacy of this class of beta blockers has not been systematic ally review ed and quantified .
OBJECTIVES To quantify the dose-related effects of various types of dual alpha and beta adrenergic receptor blockers ( dual receptor blockers ) on systolic and diastolic blood pressure versus placebo in patients with primary hypertension .