Current and Future Status of Beta‐blockers in the Treatment of Hypertension

Abstract

Beta-adrenergic receptor blockers (beta-blockers) are effective and safe antihypertensive drugs, and have been recommended as first-line therapy for hypertension by all Joint National Committees (JNCs) for the prevention, detection, evaluation, and treatment of high blood pressure (BP) from the first to the last (JNC-7) in 2003. However, recently questions have been raised by several investigators regarding the antihypertensive effectiveness and safety of these drugs. The Medline literature on this subject was searched and pertinent studies were retrieved. Other pertinent references from existing publications were retrieved and analyzed up to 2007. Additionally, a historical perspective on the discovery of beta-blockers and their mechanism of action is given. Most of the reviewed short-term and long-term clinical trials demonstrate an effective and safe antihypertensive pattern for the beta-blockers. The weaknesses identified include the adverse effect of older beta-blockers on glucose control and stroke protection, especially in older persons. These adverse effects are attributed to their mechanism of action and BP effectiveness. On the basis of the evidence presented, beta-blockers are effective and safe antihypertensive drugs and should still be recommended as first-line therapy in most uncomplicated hypertensive patients, either alone or in combination with other drugs. There are reservations regarding their administration to diabetic and older hypertensive patients. However, when compelling indications for their use exist, they should not be withheld.

What is the role, if any, for beta-blockers as initial therapy for uncomplicated hypertension?

“…Vasodilating betablockers, in particular, can be distinguished from other agents in this class on the basis of their hemodynamic profile and vascular effects [15][16][17]. Accumulating evidence indicates that the deleterious metabolic effects described above are not observed with newer vasodilating beta-blockers [10,12,13].…”

“…In addition to inhibiting sympathetic outflow, beta-blockers may exert their antihypertensive effects through suppressing renin release from the juxtaglomerular cells of the kidney and by reducing catecholamine release via presynaptic beta-receptor blockade [14,15,17]. Hemodynamically, conventional nonselective beta-blockers reduce cardiac output (CO) via a decrease in heart rate (HR); this is accompanied by an increase in systemic vascular resistance, likely through unopposed actions on alpha 1 -receptors [14,17].…”

“…Hemodynamically, conventional nonselective beta-blockers reduce cardiac output (CO) via a decrease in heart rate (HR); this is accompanied by an increase in systemic vascular resistance, likely through unopposed actions on alpha 1 -receptors [14,17]. Similarly to RAS blockers and CCBs, however, newer vasodilating beta-blockers reduce peripheral vascular resistance (PVR), increase stroke volume, and maintain or increase CO, and therefore may be more physiologically appropriate as antihypertensive agents than conventional beta-blockers [15][16][17]21].…”

Risk of Insomnia Attributable to β-Blockers in Elderly Patients with Newly Diagnosed Hypertension

“…Although socioeconomic variables, family relationship, and behavioral and environmental factors relevant to insomnia were not available, we did identify the physical illnesses known to cause insomnia and accounted for illnesses in multiple regression models. Confounding by indication where ¢-blockers with lower risk of insomnia were prescribed to patients who were prone to this side effect, although possible, could be limited in the current study because, according to the literature, 40) side effects (including the CNS risk) are rarely a consideration to physicians when choosing an antihypertensive agent. When the selection of an exposure is unrelated to the outcome of interest, the bias from confounding by indication is generally minimal.…”

Salt-Assisted Lle Combined with Field-Amplified Sample Stacking in Ce for Improved Determination of Beta Blocker Drugs in Human Urine

“…They were also recommended as the first-line therapy for hypertension by all Joint National Committees [2]. The use of beta blockers was forbidden by the Medical Commission of the International Olympic Committee because these drugs reduce the cardiac rhythm by blocking the beta-receptors in the heart; this can be useful in sports where aiming is important [3].…”