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Background   β-blocker s may protect against catecholaminergic myocardial injury in critically ill patients. Long-term  β-blocker  users are known to have lower lactate concentrations and favorable sepsis outcomes. However, the effects of β1-selective and nonselective  β-blockers  on sepsis outcomes have not been compared. This study was conducted to investigate the impacts of different  β-blocker  classes on the mortality rate in septic patients.    Methods  We retrospectively screened 2678 patients admitted to the medical or surgical intensive care unit (ICU) between December 2015 and July 2017. Data from patients who met the Sepsis-3 criteria at ICU admission were included in the analysis. Premorbid  β-blocker  exposure was defined as the prescription of any  β-blocker  for at least 1 month. Bisoprolol, metoprolol, and atenolol were classified as β1-selective  β-blockers , and others were classified as nonselective  β-blockers . All patients were followed for 28 days or until death.    Results  Among 1262 septic patients, 209 (16.6%) patients were long-term  β-blocker  users. Patients with premorbid  β-blocker  exposure had lower heart rates, initial lactate concentrations, and ICU mortality. After adjustment for disease severity, comorbidities, blood pressure, heart rate, and laboratory data, reduced ICU mortality was associated with premorbid β1-selective [adjusted hazard ratio, 0.40; 95% confidence interval (CI), 0.18–0.92;  P  = 0.030], but not non-selective  β-blocker  use.    Conclusion  Premorbid β1-selective, but not non-selective,  β-blocker  use was associated with improved mortality in septic patients. This finding supports the protective effect of β1-selective  β-blockers  in septic patients. Prospective studies are needed to confirm it.    Supplementary Information  The online version contains supplementary material available at 10.1186/s40560-021-00553-9.

Premorbid β1-selective (but not non-selective) β-blocker exposure reduces intensive care unit mortality among septic patients