Carvedilol: a third-generation β-blocker should be a first-choice β-blocker

Abstract

β-blockers are a standard of care in many clinical settings such as acute myocardial infarction, heart failure and patients at risk for a coronary event. However, not all β-blockers are the same and they vary in properties such as lipophilicity, metabolic profile, receptor inhibition, hemodynamics, tolerability and antioxidant/anti-inflammatory effects. It has been unclear whether these differences affect outcomes or if one β-blocker should be preferred over another. This review will summarize the properties of metoprolol, atenolol and carvedilol, as well as comparative experimental and clinical trials between these agents. We will provide compelling evidence of why carvedilol should be a first-line β-blocker and why it offers many advantages over the β1-selective β-blockers.

Keywords::

• atenolol
• carvedilol
• heart failure
• hypertension
• metoprolol
• myocardial infarction

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Notes

CHF: Congestive heart failure; CTR: Cardiothoracic ratio; LVDd: Left ventricular diastolic dimension; LVEF: Left ventricular ejection fraction; PVC: Premature ventricular contraction; SCD: Sudden cardiac death.

Data taken from [26].