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Beta-blockers can precipitate or aggravate symptoms of arterial insufficiency in patients with peripheral vascular disease.

The precise mechanism for the beneficial effects of beta-blockers in heart failure has not been elucidated.

Metoprolol is a beta 1selectivecardioselectiveadrenergic receptor blocking agentThis preferential effect is not absolutehoweverand at higher plasma concentrationsmetoprolol also inhibits beta 2adrenoreceptorschiefly located in the bronchial and vascular musculatureMetoprolol has no intrinsic sympathomimetic activityand membrane-stabilizing activity is detectable only at plasma concentrations much greater than required for beta-blockadeAnimal and human experiments indicate that metoprolol slows the sinus rate and decreases AV nodal conduction.

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