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Beta-Blockers in Heart Failure: Are Pharmacological Differences Clinically Important?

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Abstract

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 beta1-adrenergic receptors while carvedilol blocks also beta2-, and alpha1- 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.

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Authors and Affiliations

  1. Cattedra di Cardiologia, Università di Brescia, Italy

    Marco Metra & Livio Dei Cas

  2. Deptartment of Cardiology, Ospedale di Cattinara, Trieste, Italy

    Andrea di Lenarda

  3. National Heart and Lung Institute, Imperial College, London, UK

    Philip Poole-Wilson

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  1. Marco Metra
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  2. Livio Dei Cas
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  3. Andrea di Lenarda
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  4. Philip Poole-Wilson
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Correspondence to Marco Metra.

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Metra, M., Cas, L.D., di Lenarda, A. et al. Beta-Blockers in Heart Failure: Are Pharmacological Differences Clinically Important?. Heart Fail Rev 9, 123–130 (2004). https://doi.org/10.1023/B:HREV.0000046367.99002.a4

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