Class Explorer · Cardiovascular

Beta blockers

Competitive antagonists at beta adrenergic receptors; the clinical personality of each agent is its selectivity and its pharmacokinetics.

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Members

MetoprololThe workhorse cardioselective beta blocker, in fast and slow clothing.BisoprololThe most beta-1 selective of the common beta blockers, once daily by design.CarvedilolThe beta blocker that also opens arteries, which is why heart failure likes it.AtenololThe water-soluble beta blocker: fewer dreams, more dependence on the kidney.

Also in this class: Carvedilol (alpha+beta, HFrEF-proven) · Atenolol (hydrophilic, renal) · Propranolol (non-selective, crosses CNS freely) · Labetalol (alpha+beta, pregnancy hypertension). Full pages arrive as the library grows.

Compare the members

Drug	β1 selectivity	Half-life	Elimination	HFrEF evidence
Metoprolol	Selective (relative)	3-7 h IR	Hepatic (CYP2D6)	Succinate: yes
Bisoprolol	Most selective	10-12 h	Renal + hepatic	Yes
Carvedilol	Non-selective, plus alpha-1	7 to 10 h	Hepatic	Trial-proven in HFrEF
Atenolol	Beta-1 selective	6 to 7 h	Renal	No HFrEF evidence

Metoprolol

β1 selectivity: Selective (relative)
Half-life: 3-7 h IR
Elimination: Hepatic (CYP2D6)
HFrEF evidence: Succinate: yes

Bisoprolol

β1 selectivity: Most selective
Half-life: 10-12 h
Elimination: Renal + hepatic
HFrEF evidence: Yes

Carvedilol

β1 selectivity: Non-selective, plus alpha-1
Half-life: 7 to 10 h
Elimination: Hepatic
HFrEF evidence: Trial-proven in HFrEF

Atenolol

β1 selectivity: Beta-1 selective
Half-life: 6 to 7 h
Elimination: Renal
HFrEF evidence: No HFrEF evidence

Shared across the class

Indications: Hypertension (not first-line uncomplicated) · Angina · Rate control in AF · HFrEF (specific agents) · Post-MI
Adverse effects: Bradycardia · Fatigue · Hypotension · Bronchospasm (beta-2 spillover) · Masked hypoglycemia · Rebound on abrupt stop
Contraindications: High-grade AV block without pacemaker · Decompensated heart failure · Severe bradycardia
Monitoring: Heart rate · Blood pressure · Fatigue and exercise tolerance · Glucose awareness in insulin users

What makes each agent different

Selectivity: bisoprolol > metoprolol >> propranolol (none). Selectivity is relative and fades with dose.
HFrEF evidence belongs to three: bisoprolol, carvedilol, metoprolol succinate, not the class.
Lipophilicity: propranolol and metoprolol enter the CNS (dreams, fatigue); atenolol mostly does not.
Elimination: atenolol renal, metoprolol hepatic (CYP2D6), bisoprolol balanced. Choose around the failing organ.
Carvedilol and labetalol add alpha blockade: more BP effect, more orthostasis.

'Beta blocker' is a strategy, not a prescription: the agent choice carries the evidence.

Last reviewed 2026-08-15 · Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed.