Should β Blockers No Longer Be Considered First-line Therapy for the Treatment of Essential Hypertension Without Comorbidities?

Abstract

Although most guidelines committees historically recommended initial diuretics and/or β blockers for uncomplicated hypertension, clinical trial outcomes analyzed in the last 5 to 7 years have been suboptimal with atenolol, the world's most popular β blocker. Several meta-analyses have suggested that despite lowering blood pressure, any and all β blockers inadequately protect hypertensive patients from cardiovascular events. These phenomena have been attributed to ineffective lowering of central aortic or inter-visit blood pressures, or adverse metabolic effects (particularly when combined with diuretics). Although there has never been a head-to-head comparison of atenolol with any other β blocker in hypertensive patients, indirect comparisons can be done with network and Bayesian meta-analyses, which suggest that heterogeneity of β-blockers' pharmacology also extends to outcomes. Although once-daily atenolol as initial antihypertensive therapy may be unwise, whether initial β blockers newer than atenolol reduce cardiovascular risk to the same extent as other antihypertensive drugs should be answered with more clinical trials.

OPTIMAL ORGANOPROTECTION, CONTROL OF bLOOD PRESSURE AND METAbOLIC DISORDER WITH THE FIxED COMbINATION OF LISINOPRIL, AMLODIPINE AND ROSUVASTATIN IN SYSTEMIC HYPERTENSION

“…Во-вторых, в настоя-щее время взаимосвязь улучшения показателей эла-стичности сосудов различного калибра, выживаемости и снижения риска развития сердечно-сосудистых осложнений (ССО) при АГ можно считать доказан-ной [3]. При этом, обнаружены принципиальные различия как между классами антигипертензивных препаратов, так и их отдельными представителями [4][5][6][7][8][9][10][11] и различными комбинациями антигипертен-зивных препаратов [12][13][14] по ангиопротективному эффекту (влияние на индекс аугментации, централь-ное систолическое и пульсовое давление) и, в конеч-ном итоге, на типичные конечные точки (общую и сердечно-сосудистую смертность, инсульт, инфаркт миокарда) [15,16]. Было показано, что при достиже-нии одинакового уровня АД меньшая смертность имела место у пациентов с АГ при снижении скоро-сти распространения пульсовой волны (СПВ) [17].…”

Beta-Blockers in the Management of Hypertension and/or Chronic Kidney Disease

“…Atenolol is a beta1-selective agent, and it has been widely used as the control drug in large randomized prospective controlled trials of newer antihypertensive agents such as calcium channel blockers and renin-angiotensin (RA) system blockers. Table 1 summarizes the plausible reasons why beta-blockers are considered to be relatively ineffective for the prevention of cardiovascular events [7–9]. …”

Implication of different initial beta blockers on treatment persistence: atenolol vs new‐generation beta blocker, a population‐based study

“…The new‐generation beta blockers with improved pharmacological properties were introduced to the market and are currently in use for the treatment of hypertension. Substantial differences exist regarding receptor selectivity, lipid vs water solubility, intrinsic sympathomimetic activity, and vasodilating properties, which may play a role in yielding different clinical outcomes either due to pharmacologic heterogeneity contributing to metabolic adverse effect or due to compliance to the medication …”

“…Although initial beta blockers were traditionally recommended for the treatment of uncomplicated hypertension in most guidelines, recent analysis result on clinical outcome was suboptimal with atenolol. 1,2 Influened by the results of recent meta analyses that suggested all beta blockers have inadequate protection for hypertension patient from cardiovascular event, 2 the eighth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 8) excluded beta blockers from first-line therapy for the treatment of uncomplicated hypertension, either alone or in combination with drugs from other antihypertensive drug classes despite its blood pressure-lowering effect. 3 Despite the recent changes made in guidelines, the use of beta blockers as initial antihypertensive agent in patient with uncomplicated hypertension still remains prevalent.…”

“…Substantial differences exist regarding receptor selectivity, lipid vs water solubility, intrinsic sympathomimetic activity, and vasodilating properties, which may play a role in yielding different clinical outcomes either due to pharmacologic heterogeneity contributing to metabolic adverse effect or due to compliance to the medication. 1,5 It has been carefully suggested that increased risks of mortality and cardiovascular events are due, in part, to the lack of persistent use of antihypertensive medications. 6 About half of all treated patients discontinue their antihypertensive medications within 2 years due to various reasons including intolerance to adverse event, and such discontinuation is associated with an increased blood pressure and increased risks of acute myocardial infarction and stroke.…”