Beta-blockers: a time for reappraisal

Claims could not easily be made that beta-blockers as a group are the most potent or best-tolerated antihypertensive drugs. However, they have a very important role in the management of hypertensive patients who are being treated to prevent cardiovascular complications. Whilst stroke incidence can be reduced by effective blood pressure control, preventing the progress of coronary artery disease to reduce the patients risk of having a myocardial infarct, dying suddenly or developing heart failure is more difficult. Beta-blockers, particularly lipophylic beta-blockers, are the antihypertensive drugs for which there is most evidence that they reduce coronary mortality. Furthermore, the adverse effects of beta-blockers have been exaggerated and there is good evidence that the elderly, diabetics, and those with impaired left ventricular function do derive considerable benefit from beta-blockade. Low plasma concentrations of beta1 selective drugs are clinically effective and are well tolerated.