Beta blockers and their combinations in the management of hypertension

Abstract

Beta blockers have been prescribed for the treatment of primary hypertension for a very long time. Currently, it is doubtful whether this is still a good idea. In fact, many are of the opinion that beta blockers should be relegated to a fourth-line drug, if used at all, for the treatment of hypertension. So what happened? Why the change of heart? Basically, two issues are driving this new view of beta blockers. Firstly, beta blockers are cardioprotective when given to patients with a recent myocardial infarction and reduce subsequent mortality significantly. Certain types of beta blockers reduce mortality in patients with heart failure. This efficacy in secondary protection was translated to primary prevention without a critical assessment, and this is particularly the case in hypertension. Secondly, reducing blood pressure by any means may not automatically translate into reduced cardiovascular morbidity and mortality. This happened with beta blockers in the primary treatment of hypertension.