Beta-Blockers in Hypertension

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 beta blockers are still an appropriate therapy given outcomes data from other antihypertensive drug classes. However, beta 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 nonvasoclilating, traditional beta blockers, such as atenolol. However, findings with traditional beta blockers may not be extrapolated to other members of the class, particularly those agents with vasodilatory activity. Vasodilatory beta 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 beta blockers. Vasodilating ability may also ameliorate some of the concerns associated with traditional beta 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 beta 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 beta blockers in hypertension, recognizing that there are patients for whom beta blockers, particularly those with vasodilatory actions, are an appropriate treatment option. (C) 2010 Elsevier Inc. All rights reserved. (Am J Cardiol 2010;106:1819-1825)