Key result
Beta-blockers trail other antihypertensives in stroke protection, limiting first-line use to CAD or HF.
Why the study?
Guideline recommendations against beta-blockers as first-line hypertension therapy have been disputed by studies suggesting they are effective, safe, and viable as first-line treatment.
Do beta-blockers improve blood pressure and prevent stroke compared to other antihypertensive drugs in patients with hypertension?
Do beta-blockers improve blood pressure and prevent stroke compared to other antihypertensive drugs in patients with hypertension?
Answers are grounded in this paper and cite their sources.
This review supports current guidelines that beta-blockers should not be used as first-line therapy for uncomplicated hypertension due to inferior antihypertensive and stroke-protective effects.
There are currently three generations of beta-adrenergic blockers for the treatment of hypertension and cardiovascular diseases. The 1st generation caused vasoconstriction and bronchoconstriction due to β1 + β2 receptor blockade and unopposed α1 receptors. The 2nd generation of beta-blockers has lesser adverse effects than the 1st generation with the 3rd generation beta-blockers having much lesser effects than the other two generations. Current US and International guidelines do not recommend beta-blockers as first-line therapy of hypertension, but only in the presence of coronary artery disease or heart failure due to their lesser antihypertensive effect. These recommendations are disputed by several older and recent studies which have shown that the beta-blockers are effective and safe for the treatment of hypertension and could be used as first-line therapy. To clarify this issue a Medline search of the English language literature was conducted between 2012 and 2021 and 30 pertinent papers were selected. The data from these studies show that the beta-blockers have inferior antihypertensive and stroke protective effect compared with the other classes of antihypertensive drugs and should be used as first line therapy only in patients with hypertension associated with coronary artery disease or heart failure. The information from these papers and collateral literature will be discussed in this perspective.
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Chrysant et al. (2022) conducted a review in Hypertension and cardiovascular diseases. Beta-adrenergic blockers vs. Other classes of antihypertensive drugs was evaluated on Antihypertensive and stroke protective effect. Beta-blockers have inferior antihypertensive and stroke protective effects compared with other antihypertensive classes, and should be first-line therapy only in patients with CAD or heart failure.
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