Use of β ‐ Adrenergic Receptor Blockers in Blacks

Abstract

Beta adrenergic receptor blockers (beta-blockers) are an important class of drugs in the management of patients with cardiovascular diseases. These drugs have been shown to reduce mortality in hypertension and prolong survival in patients with coronary heart disease. Although hypertension and coronary heart disease account for the majority of excess cardiovascular morbidity and mortality in blocks, beta-blockers continue to be underprescribed in this ethnic group. The magnitude of blood pressure reduction in black patients with hypertension has been consistently less during monotherapy with nonselective beta-blockers than with diuretics. However, the highly selective beta-blocker bisoprolol has been shown to be as effective as diuretics and is equally effective in black and nonblack patients with hypertension. In general, no racial differences in efficacy are noted when beta-blockers are used with diuretics as combination therapy for hypertension. Black patients should not be denied beta-blocker therapy because of an anticipated suboptimal response, especially when there are clear indications for treatment (e.g., for migraine, hyperthyroidism, arrhythmia control, and after myocardial infarction).

Racial Analysis of Patients With Myocardial Infarction Complicated by Heart Failure and/or Left Ventricular Dysfunction Treated With Valsartan, Captopril, or Both

“…Adverse events. Clinical studies indicate that the reduction in blood pressure for African-American patients compared with white patients is less with a beta-blocker, an ACE inhibitor, or an ARB when used as monotherapy (33)(34)(35)(36)(37). Consistent with those studies, African Americans had a diminished blood pressure response to ACE inhibitors and ARBs compared with white Americans, and consequently had a lower rate of clinically significant hypotension.…”

Beta-blockers have a beneficial effect upon endothelial function and microalbuminuria in African-American subjects with diabetes and hypertension

“…However, in contrast to their effects on hypertension in one study, captopril, an ACE inhibitor, reduced and isradipine, a CCB, increased proteinuria in African Americans with type 2 diabetes mellitus and nephropathy (16). Beta-blockers in general have been felt to be less than perfect choice for hypertension control in African Americans (17)(18)(19). Thus, a variety of reasons have led to under prescription of beta-blockers in African American population including a perception of their being less efficacious in slowing the rate of glomerular filtration rate decline in subjects with mild to moderate hypertensive renal insufficiency (18;19) and considerably less blood pressure reduction in during monotherapy with nonselective beta-blockers than with diuretics (17).…”

“…Beta-blockers in general have been felt to be less than perfect choice for hypertension control in African Americans (17)(18)(19). Thus, a variety of reasons have led to under prescription of beta-blockers in African American population including a perception of their being less efficacious in slowing the rate of glomerular filtration rate decline in subjects with mild to moderate hypertensive renal insufficiency (18;19) and considerably less blood pressure reduction in during monotherapy with nonselective beta-blockers than with diuretics (17). Our study clearly demonstrates that beta-blockers are not only safe and effective choice of hypertensive but also have a beneficial effect on endothelial function and nephropathy in high risk type 2 diabetic African Americans.…”

Hypertension‐Related Morbidity and Mortality in African Americans—Why We Need to Do Better

“…2,15 However, a key point that needs to be considered is that when given in combination with a diuretic, African Americans respond as well to β blockers, ACE inhibitors, and ARBs as other racial groups. 62 Combination therapy using antihypertensive agents with differing mechanisms of action confers an additive BP-lowering benefit compared with monotherapy. [63][64][65][66] Relative to high-dose monotherapy, the combination of two agents with complementary/differing mechanisms of action produces additional decreases in SBP and DBP in the range of 8 to 11 mm Hg and 4 to 6 mm Hg, respectively.…”