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Nonselective versus selective beta-blockers in the management of chronic heart failure: clinical implications of the carvedilol or Metoprolol European Trial.

The abundance of evidence supporting beta-blocker therapy has resulted in the widespread acceptance of these drugs in the treatment of heart-failure patients. However, beta-blockers are not a homogeneous class of drugs, and important differences in efficacy have been noted between different members of the class. Thus, practicing physicians are faced with a choice when selecting a particular beta-blocker for treating heart failure. One of the considerations is whether to choose a selective or a nonselective beta-blocker. The results of the Carvedilol or Metoprolol European Trial indicate that carvedilol, a third-generation, nonselective beta-blocker with additional a-blocking, antioxidant, and other properties, is clearly superior to a beta1-blocking drug, metoprolol tartrate. The choice between these drugs is therefore unambiguously in favor of carvedilol.