Long-term treatment of hypertension with beta-blockers lacking intrinsic sympathomimetic activity reduces cardiac complications, despite variable metabolic effects.
Does beta-blocker therapy reduce cardiac complications in patients with hypertension and coronary artery disease despite associated metabolic effects?
Beta-blockers without intrinsic sympathomimetic activity should be considered for treating hypertension in patients with or at high risk for coronary artery disease, as their metabolic effects appear to have little clinical relevance.
Despite the strong association between hypertension and accelerated atherosclerosis, and the known beneficial clinical effects of beta-blockers in patients with coronary artery disease, antihypertensive trials of beta-blockers have shown only modest protection against fatal and nonfatal myocardial infarction. This review explores the explanations put forth for this apparent failure of beta-blockers. It also examines the clinical relevance of the metabolic effects of beta-blockers within the framework of the heterogeneity of this class of drugs. Recent evidence indicates that long-term treatment of hypertension with beta-blockers that do not possess intrinsic sympathomimetic activity reduces the occurrence of cardiac complications of hypertension. There are no data to show a quantified effect on clinical outcome of the lipid and glucose changes associated with beta-blocker therapy. The metabolic influence of these drugs varies considerably within the class and may be of little clinical relevance. Unless it is contraindicated, an appropriate beta-blocker should be considered for the treatment of hypertension in patients who have coronary artery disease or who are at high risk for coronary artery disease.
James F. Burris (Mon,) conducted a review in Hypertension and coronary artery disease. Beta-blockers was evaluated. Long-term treatment of hypertension with beta-blockers lacking intrinsic sympathomimetic activity reduces cardiac complications, despite variable metabolic effects.