Carvedilol and Alpha Blockade: Does it Matter in the Long Run?

Of the three beta blockers recommended in patients with heart failure with reduced ejection fraction, only carvedilol exerts antagonist effects at α1 receptors. However, its benefits in heart failure are presumably a result of myocardial β1 receptor inhibition, as the β1-selective agents bisoprolol and metoprolol succinate confer similar improvements in morbidity and mortality. So what’s the significance of α1 receptor blockade?