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Due to the larger sample size from the two unpublished studies , carvedilol provided a better estimate of BP lowering effect than labetalol .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 .
Effects of Carvedilol on Blood Pressure in Patients with Mild to Moderate Hypertension
Summary Carvedilol 12.5 , 25 and 50 mg was administered once daily for 4 weeks to patients with mild to moderate hypertension . The purpose of the study was to investigate the antihypertensive action of carvedilol when administered once daily and to investigate the pharmacokinetics of carvedilol in patients with mild to moderate hypertension . Measurable decreases in blood pressure ( BP ) occurred within 1 hour after the first dose . Peak decreases in supine diastolic blood pressure ( DBP ) were 9.0 ± 6.8 , 15.5 ± 6.7 , 14.7 ± 10.6 and 22.5 ± 7.6 mm Hg ( ± SD ) for the placebo , 12.5 , 25 and 50 mg carvedilol groups , respectively , and occurred between 3 and 7 hours after the dose . Administration of carvedilol once daily for 4 weeks kept supine DBP below baseline levels for 24 hours . Trough supine DBP after 4 weeks of treatment were 0.6 ± 6.5 , 7.3 ± 7.9 , 8.8 ± 7.4 and 12.1 ± 3.8 mm Hg ( ± SD ) below baseline . Serum levels of carvedilol were proportional to the dose . Peak serum levels were 39 ± 27 , 75 ± 38 and 161 ± 131 μ/L for carvedilol 12.5 , 25 and 50 mg . The kinetics of carvedilol did not change with repeated administration . Carvedilol was well tolerated ; 2 patients experienced dizziness associated with postural hypotension after administration of the 50 mg dose . Carvedilol 12.5 , 25 and 50 mg effectively reduced BP for 24 hours when administered once daily
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 .