We investigated the effect of the beta 1-selective blocker metoprolol on the beta-adrenergic receptor density of circulating lymphocytes in patients with dilated cardiomyopathy. Nine men in New York Heart Association functional classes II (six patients) and III were given metoprolol for 6 months (mean dose 45.6 +/- 18.1 mg). Their cardiac function was assessed by echocardiography. Although there was no difference in the heart rate or pressure rate products, the end-systolic and end-diastolic dimensions significantly decreased in six patients after metoprolol treatment. The ejection fraction, fractional shortening, and mean left ventricular circumferential shortening were significantly increased after the treatment. beta-Adrenoceptor densities of lymphocytes, examined by iodine 125-labeled iodocyanopindolol, were reduced in patients at entry but recovered to normal levels after the metoprolol treatment. The dissociation constants did not differ at any stage of the disease. The relationship between beta-adrenoceptor densities in lymphocytes and echocardiographic parameters showed a positive correlation with the plasma norepinephrine concentration. This study thus provides evidence that long-term metoprolol therapy for dilated cardiomyopathy is associated with beta-receptor up-regulation, and the restoration of myocardial beta-receptor density may be associated with the improved cardiac function as determined by echocardiography.