Continuing evolution of the role of β-blockers in the treatment of hypertension

The β-blockers have evolved into one of the most prescribed classes of drugs for the treatment of cardiovascular disease in general, and hypertension in particular. However, the class is one of the more heterogenous groups in pharmacological agents. The evolution of the β-blockers has included increased selectivity for the β1 receptor (cardioselective) and, more recently, development of β-blockers with vasodilating properties. As a result of this evolution, the current vasodilating β-blockers, i.e., nebivolol and carvedilol, have a better hemodynamic profile and are devoid of many of the troublesome side effects, for example, fatigue, sexual dysfunction and increased insulin resistance and disturbances in glucose metabolism, found in the traditional β-blockers. Nebivolol produces vasodilation by a mechanism that includes increased bioavailability of nitric oxide that may bring other benefits. With these improvements in design, the future for the use of β-blockers appears bright.