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

beta-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 beta-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 beta-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 beta-blocker and why it offers many advantages over the beta 1-selective beta-blockers.