Carvedilol is preferred over metoprolol in patients with heart failure with reduced ejection fraction (HFrEF) in part because carvedilol additionally:

• A Has intrinsic sympathomimetic activity that maintains cardiac output
• B Blocks alpha-1 receptors, providing afterload reduction in addition to beta blockade ✓
• C Is a pure beta-2 selective agent with minimal negative inotropic effect
• D Inhibits angiotensin-converting enzyme, reducing aldosterone levels

Explanation

Carvedilol is a third-generation non-selective beta-blocker with additional alpha-1 adrenoceptor blocking activity, which reduces systemic vascular resistance (afterload) in addition to its negative chronotropic and anti-remodeling effects. It also has antioxidant properties. In HFrEF, the combined alpha-1 + beta blockade leads to superior outcomes compared to pure beta-1 blockade in some trials. It has no intrinsic sympathomimetic activity.

Reference: KD Tripathi, Essentials of Medical Pharmacology, 8th ed.

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Written and medically reviewed by the StethoPrep medical team.