Beta-Blockers in Hypertension

• Published in: The American journal of cardiology Vol. 106; no. 12; pp. 1819 - 1825
• Main Author: Ram, C. Venkata S., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 15.12.2010; Elsevier; Elsevier Limited
• Subjects: Adrenergic beta-Antagonists - therapeutic use; Arterial hypertension. Arterial hypotension; Beta blockers; Biological and medical sciences; Blood and lymphatic vessels; Blood pressure; Blood Pressure - drug effects; Cardiology. Vascular system; Cardiovascular; Humans; Hypertension; Hypertension - drug therapy; Hypertension - physiopathology; Medical sciences; Medical treatment; Meta-analysis; Practice Guidelines as Topic; Treatment Outcome; Hypertension; Cardiovascular disease; Circulatory system; Cardiology
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2010.08.023

Beta blockers have been used in the treatment of cardiovascular conditions for decades. Despite a long history and status as a guideline-recommended treatment option for hypertension, recent meta-analyses have brought into question whether β blockers are still an appropriate therapy given outcomes data from other antihypertensive drug classes. However, β blockers are a heterogenous class of agents with diverse pharmacologic and physiologic properties. Much of the unfavorable data revealed in the recent meta-analyses were gleaned from studies involving nonvasodilating, traditional β blockers, such as atenolol. However, findings with traditional β blockers may not be extrapolated to other members of the class, particularly those agents with vasodilatory activity. Vasodilatory β blockers (i.e., carvedilol and nebivolol) reduce blood pressure in large part through reducing systemic vascular resistance rather than by decreasing cardiac output, as is observed with traditional β blockers. Vasodilating ability may also ameliorate some of the concerns associated with traditional β blockade, such as the adverse effects on metabolic and lipid parameters, including an increased risk for new-onset diabetes. Furthermore, vasodilating ability is physiologically relevant and important in treating a condition with common co-morbidities involving metabolic and lipid abnormalities such as hypertension. In patients with hypertension and diabetes or coronary artery disease, vasodilating β blockers provide effective blood pressure control with neutral or beneficial effects on important parameters for the co-morbid disease. In conclusion, it is time for a reexamination of the clinical evidence for the use of β blockers in hypertension, recognizing that there are patients for whom β blockers, particularly those with vasodilatory actions, are an appropriate treatment option.