title: 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.
authors.affiliation: Wegmans Pharmacy, 500 South Meadow Street, Ithaca, NY 14850, USA. jjdinicol@gmail.com
authors.forename: James J
authors.initials: JJ
authors.lastname: DiNicolantonio
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Hackam
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D000818:Animals; D000959:Antihypertensive Agents / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D001262:Atenolol / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D002227:Carbazoles / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D000077261:Carvedilol; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology; D008790:Metoprolol / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use; D009203:Myocardial Infarction / Q000209:etiology / Q000517:prevention & control; D011412:Propanolamines / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D055502:Secondary Prevention; D013564:Sympathetic Nervous System / Q000187:drug effects; D014665:Vasodilator Agents / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use
chemical_list: D000319:Adrenergic beta-Antagonists; D000959:Antihypertensive Agents; D015415:Biomarkers; D002227:Carbazoles; D011412:Propanolamines; D014665:Vasodilator Agents; D000077261:Carvedilol; D001262:Atenolol; D008790:Metoprolol