[Beta blockers--1997 update]

Abstract

Beta blockers have been used as first-line drugs in the treatment of numerous cardiovascular disorders such as hypertension and ischemic heart disease, as well as for certain non-cardiovascular diseases for more than 30 years. However, the administration of these safe and effective drugs declined during the 1980s, whereas the use of others such as calcium antagonists and ACE inhibitors increased for these indications, frequently without convincing evidence of any clinical advantages of these agents in hard end points. During the past two or three years there has been a renaissance of beta adrenoceptor antagonists, most probably due to increasing awareness that beta blockers have been shown to reduce morbidity and mortality when compared with other therapeutic agents or placebo in numerous diseases. Furthermore, congestive heart failure has changed from being a contraindication to an indication, and suspected side effects were not confirmed on further investigation. Last but not least the reasonable costs of beta blocking drugs may have become a more important consideration than before. The trend back to beta blockers may also be due to the fact that physicians attach more importance to effects on the hard end points, namely a decrease in morbidity and mortality, than to surrogate end points. According to the present state of the art, beta blockers should be recognized as the drugs of choice, particularly in the treatment of arterial hypertension and coronary artery disease (especially after myocardial infarction), unless contraindications are present or unacceptable side effects occur. Congestive heart failure, peripheral arterial disease (PAD) and diabetes mellitus are no longer considered absolute contraindications.