Carvedilol: Is This Beta Blocker the Best for Heart Failure?

Beta blockers save lives after heart attacks. They also help people with heart failure live longer and healthier lives. This is partly because they keep someone’s blood pressure and heart rate in a safe range. But it’s also because they make the heart less sensitive to stress. 

Carvedilol (Coreg) was designed to be the best beta blocker for heart failure. But now it appears that metoprolol succinate (Toprol XL) and bisoprolol (Zebeta) may share that title. So you may be wondering which beta blocker is better? Let’s look at the recent evidence.

What is carvedilol?

Carvedilol is an example of a beta blocker. In general, beta blockers slow down the heart rate and lower blood pressure. They do this by blocking beta receptors in the body. These receptors help release adrenaline into the bloodstream, which elevates the heart rate and blood pressure. Beta blockers work to turn down this reaction. In turn, this reduces stress on the heart.

Carvedilol vs. atenolol and other beta blockers for heart failure

Each beta blocker is a little different. There are two groups of beta blockers: non-selective and selective beta blockers. 

• Carvedilol is a “non-selective beta blocker.” That means it blocks all beta receptors throughout the body. That includes receptors in the lungs and kidneys. 

• Atenolol and metoprolol are “selective beta blockers.” This means they mainly act on specific beta receptors in the heart — beta-1 receptors. 

Why does this matter? Well you might think you’d want a medication that only affects the heart. But carvedilol also works on beta-2 receptors. Beta-2 receptors are in the heart as well as throughout the body. It turns out that these are important in heart failure. 

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Carvedilol also blocks the alpha-1 receptor. These receptors also react to adrenaline and other substances that make the heart work harder. So by blocking both the beta and the alpha receptors, carvedilol can do more to prevent the heart from overworking.

For this reason, carvedilol is usually the first-choice beta blocker for heart failure. Although the long-acting version of metoprolol — metoprolol succinate — has similar benefits to carvedilol. 

It’s important to know that short-acting metoprolol — metoprolol tartrate — may make heart failure worse. Bisoprolol is another proven option for heart failure that is not commonly used in the U.S. But there is less research on other beta blockers like atenolol for heart failure. 

How effective is carvedilol for treating heart failure?

Until the 1990s, beta blockers were not used for heart failure. But in 1996, a study found that carvedilol reduced the risk of dying from heart failure by about 65%. People who took carvedilol were also less likely to be hospitalized for symptoms of heart failure. 

So, still today, carvedilol is a standard part of treatment for heart failure. And it’s the combined effects of carvedilol with other heart failure treatment that seem to be most powerful. 

Is carvedilol better for survival after a heart attack?

Beta blockers are considered standard carefor most people who survive a heart attack. That’s because beta blockers: 

• Lower blood pressure

• Decrease the heart rate

• Decrease the workload on the heart

• Block the effects of adrenaline and other stressors on the heart

• Reduce the risk of dangerous heart rhythms, like ventricular tachycardia and atrial fibrillation

Metoprolol succinate is a common choice of beta blocker after a heart attack. But carvedilol might be a better option if the heart muscle is weaker than normal. 

Can you take carvedilol for heart failure if you also have COPD or asthma?

Carvedilol affects beta receptors in the lungs. This is important for people with asthma because blocking beta receptors in the lungs can worsen asthma. In that case, metoprolol may be a better choice. 

COPD (chronic obstructive pulmonary disease), which includes both emphysema and chronic bronchitis, is a bit different. Some people have both asthma and COPD together. But people with only COPD can usually take carvedilolwithout any lung problems.   

Can carvedilol hurt the kidneys?

Since it’s a non-selective beta blocker, you might wonder if carvedilol affects the kidneys. It’s an important question, since many people with heart conditions also have kidney problems. The good news is that carvedilol is generally safe for the kidneys. 

By lowering blood pressure, it can help to protect the kidneys. And a study that looked at the effect of carvedilol on kidney function found no evidence of harm.

What are some alternatives to carvedilol?

When it comes to beta blockers for heart failure, carvedilol is a common first choice. But if you have side effects or other reasons to avoid it, there are some other options. Here are some good alternatives if you have one of these conditions:

• Asthma: metoprolol succinate, bisoprolol, or nebivolol

• Erectile dysfunction: bisoprolol or nebivolol

• Peripheral arterial disease: nebivolol

• Atrial fibrillation: metoprolol succinate

Of course, some people may not be able to take beta blockers at all. If you have a low heart rate or low blood pressure, then beta blockers can make these problems worse. Heart failure usually requires a combination of medications. So, in this situation, your provider will find a regimen that works best for you.

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Written by:

Sarah A. Samaan, MD

Sarah Samaan, MD, FACC, FACP, FASE is a board-certified cardiologist who practiced clinical cardiology for nearly 30 years. She is a member of the American College of Cardiology, the American College of Physicians, and the American Society of Echocardiography.

Edited by:

Katie E. Golden, MD

Katie E. Golden, MD, is a board-certified emergency medicine physician and a medical editor at GoodRx.

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