Beta-blockers in hypertension.
Am J Cardiol. 2010 Dec 15;106(12):1819-25
Authors: Ram CV
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 ? blockers are still an appropriate therapy given outcomes data from other antihypertensive drug classes. However, ? 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 ? blockers, such as atenolol. However, findings with traditional ? blockers may not be extrapolated to other members of the class, particularly those agents with vasodilatory activity. Vasodilatory ? 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 ? blockers. Vasodilating ability may also ameliorate some of the concerns associated with traditional ? 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 ? 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 ? blockers in hypertension, recognizing that there are patients for whom ? blockers, particularly those with vasodilatory actions, are an appropriate treatment option.
PMID: 21126627 [PubMed - in process]