Beta and alpha blockers remain effective options for the management of essential hypertension, with beta blockers having well-documented long-term outcome benefits.
Supports beta blocker preference in hypertension with post-MI or HF; leaves open long-term outcome data for alpha blockers.
There are several lines of evidence implicating increased sympathetic activity not only in the maintenance of raised blood pressure but in the pathophysiology of hypertensive complications including atherosclerosis. Beta blockers are one of the best documented classes of drugs in terms of long term safety and improvement in outcome in hypertension. They are also well established to reduce reinfarction in patients after myocardial infarction and to improve survival in patients with congestive heart failure. Side effects of beta blockers are predictable and result from excess pharmacological activity. They can often be controlled by dose adjustments. Alpha blockers reduce peripheral resistance. They are as effective as other classes at lowering blood pressure although to date there is little or no long term outcome data with this class. Reduction of sympathetic activity with beta and/or alpha blockers should remain amongst the first choices for monotherapy (or add-on therapy) in essential hypertension.
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John L. Reid (1999) studied this question.
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