The beta blockers: are they as protective in hypertension as in other cardiovascular conditions?

Abstract

Beta blockers are frequently used to treat hypertension because of their well established safety and efficacy. Large clinical trials yield a 12%--20% decline in cardiovascular end points in hypertensive patients treated with beta blockers. However, beta blockers account for only 11% of antihypertensive prescriptions, and their use appears to be declining as newer agents with fewer side effects become available. The metabolic side effects of beta blockers have recently been examined. While they may raise triglycerides, lower high-density lipoprotein cholesterol, induce glucose intolerance, and possibly unmask diabetes, these effects have not been shown to impact their clinical effectiveness. For hypertension, beta blockers are still recommended as first-line therapy in many patients, particularly those at high risk for cardiovascular disease. They are also indicated for other cardiovascular disorders, such as congestive heart failure and postmyocardial infarction, in which mortality reductions exceed that seen with hypertension treatment in patients without cardiovascular complications. (c)2001 Le Jacq Communications, Inc.

Figure 1

Data represent equivalency of β blockers and ACE inhibitors in reducing cardiovascular end points in diabetics. ACE=angiotensin‐converting enzyme; MI=myocardial infarction; CHF=congestive heart failure. Reprinted with permission from BMJ. 1998;317:703–713. ⁵

Figure 1

Risk reduction with β blockers in the post‐MI patient MI=myocardial infarction. Adapted with permission from Moser M. Clinical Management of Hypertension. 4th ed. Caddo, OK; Professional Comm.; 1999:78–91.

Figure 1

Kaplan‐Meier survival plots for CHF patients treated with β blockers. CHF=congestive heart failure. Reprinted with permission from Lancet. 1999;353:9–13. ⁴