Beta-blockers in heart failure: are pharmacological differences clinically important?

Heart Fail Rev. 2004 Apr;9(2):123-30. doi: 10.1023/B:HREV.0000046367.99002.a4.


Beta-blockers are not an homogeneous group of agents. Only three beta-blockers, carvedilol, bisoprolol and metoprolol succinate, have had favorable effects on prognosis in controlled clinical trials in the patients with chronic heart failure. However, pharmacological differences exist between them. Metoprolol and bisoprolol are selective for beta(1)-adrenergic receptors while carvedilol blocks also beta(2)-, and alpha(1)- adrenergic receptors, and has associated antioxidant, anti-endothelin and antiproliferative properties. In COMET carvedilol was associated with a significant reduction in mortality compared to metoprolol tartrate further showing that different beta-blockers may have different effects on the outcome. These differences may be related to the ancillary properties of carvedilol or to its broader antiadrenergic profile. However, also more effective and prolonged blockade of beta1 adrenergic receptors may occur with carvedilol compared to metoprolol.

Publication types

  • Review

MeSH terms

  • Adrenergic beta-Antagonists / pharmacology*
  • Adrenergic beta-Antagonists / therapeutic use
  • Clinical Trials as Topic
  • Dose-Response Relationship, Drug
  • Heart Failure / drug therapy*
  • Heart Failure / metabolism
  • Heart Failure / mortality
  • Humans
  • Myocardial Infarction / drug therapy
  • Myocardial Infarction / metabolism
  • Myocardial Infarction / mortality
  • Receptors, Adrenergic, beta-1 / drug effects
  • Receptors, Adrenergic, beta-1 / metabolism
  • Receptors, Adrenergic, beta-2 / drug effects
  • Receptors, Adrenergic, beta-2 / metabolism


  • Adrenergic beta-Antagonists
  • Receptors, Adrenergic, beta-1
  • Receptors, Adrenergic, beta-2