As a clinical pharmacy specialist, cardiologists will ask you for your recommendations on which beta-blockers are better, carvedilol or metoprolol in patients with heart failure and diabetes. There is tantalizing evidence that carvedilol MIGHT be better. But the truth is not so clear.
The first head-to-head comparison suggests that carvedilol improves survival MORE than metoprolol. Carvedilol (Dilatrend, Dilatrol, carvid, etc) and metoprolol (Lopresor, Seloken Zoc, Logimax, etc) are both beta-blockers, but carvedilol also blocks alpha-1 receptors. Some experts think that carvedilol's alpha-1 effects might decrease ischemia and help improve outcomes. Carvedilol may be better than metoprolol for diabetes patients. This is NOT because carvedilol lowers blood pressure better, but because it doesn't INCREASE blood glucose. Other beta-blockers may increase blood glucose or affect lipids.
Carvedilol can also decrease protein in the urine. These benefits may be due to carvedilol's alpha-blocking effects. The doses of carvedilol compared to that of metoprolol appear to be very low, and generic carvedilol costs a little more than metoprolol. Finally, suggest carvedilol for HF or diabetes patients if needed because other beta-blockers may worsen glycemic control or dyslipidemia.
REFERENCES
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Farrell MH, Foody JM, Krumholz HM. beta-Blockers in heart failure: clinical applications. JAMA. 2002 Feb 20;287(7):890-7. Available at: https://jamanetwork.com/journals/jama/fullarticle/194662
Bakris GL, Fonseca V, Katholi RE, McGill JB, Messerli FH, Phillips RA, Raskin P, Wright JT Jr, Oakes R, Lukas MA, Anderson KM, Bell DS; GEMINI Investigators. Metabolic effects of carvedilol vs metoprolol in patients with type 2 diabetes mellitus and hypertension: a randomized controlled trial. JAMA. 2004 Nov 10;292(18):2227-36. Available at: https://jamanetwork.com/journals/jama/fullarticle/199763
European Society of Hypertension-European Society of Cardiology Guidelines Committee. 2003 European Society of Hypertension-European Society of Cardiology guidelines for the management of arterial hypertension. J Hypertens. 2003 Jun;21(6):1011-53. Available at: https://journals.lww.com/jhypertension/Citation/2003/06000/2003_European_Society_of_Hypertension_European.1.aspx
Kukin ML. Beta-blockers in chronic heart failure: considerations for selecting an agent. Mayo Clin Proc. 2002 Nov;77(11):1199-206. Available at: https://www.mayoclinicproceedings.org/article/S0025-6196(11)61810-7/fulltext