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?

A Problem in PARADIGM-HF: What about Black Patients?

In PARADIGM-HF, a combination of the neprilysin inhibitor sacubitril and the angiotensin receptor blocker valsartan reduced cardiovascular death and hospitalizations for heart failure compared to the ACE inhibitor enalapril. But by studying so few black patients, who have historically responded less favorably to many heart failure drugs, can we trust its widespread use in this population?