Chonnam Med J.  2009 Aug;45(2):75-78. 10.4068/cmj.2009.45.2.75.

The Role of Beta Blockers in Treating Hypertensive Patients

• Lim SY

• KMID: 2172264
• DOI: http://doi.org/10.4068/cmj.2009.45.2.75

Abstract

Beta-blockers have been used to treat hypertension for many years. Although beta-blockers can lower blood pressure, current data concerning the efficacy of these drugs have been disappointing, and the value of these drugs for patients without a compelling indication has been questioned. The early beta-blockers had significant pharmacologic disadvantages; however, new-generation beta-blockers have better pharmacologic profiles. The efficacy and tolerability of the most recently developed vasodilating beta-blockers (carvedilol and nebivolol) are currently being evaluated. Further investigation of these new beta-blockers is needed.

Keyword

Hypertension; Beta-blocker; Carvedilol; Nebivolol

MeSH Terms

Benzopyrans
Blood Pressure
Carbazoles
Ethanolamines
Humans
Hypertension
Propanolamines
Nebivolol
Benzopyrans
Carbazoles
Ethanolamines
Propanolamines

Reference

1. Mayor S. NICE removes beta blockers as first line treatment for hypertension. BMJ. 2006. 333:8.

2. Bloch MJ. British hypertension society recommends that beta-blockers are no longer indicated as initial treatment of hypertension: has the pendulum swung too far? J Clin Hypertens. 2007. 9:99–102.

3. Sever P. New hypertension guidelines from the National Institute for Health and clinical excellence and the british hypertension society. J Renin Angiotensin Aldosterone Syst. 2006. 7:61–63.

4. Taylor EN, Hu FB, Curhan GC. Antihypertensive medications and the risk of incident type 2 diabetes. Diabetes Care. 2006. 29:1065–1070.

5. Dahlof B, Sever PS, Poulter NR, Wedel H, Beevers DG, Caulfield M, et al. Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendroflumethiazide as required, in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA): a multicentre randomised controlled trial. Lancet. 2005. 366:895–906.

6. Bristow MR, Ginsberg R, Minobe WA, Cubiccotti RS, Sageman WS, Lurie K, et al. Decreased catecholamine sensitivity and beta-adrenergic receptor density in failing human hearts. N Engl J Med. 1982. 307:205–211.

7. Bristow MR. Pathophysiologic and pharmacological rationales for clinical management of chronic heart failure with beta-blocking agents. Am J Cardiol. 1993. 71:12C–22C.

8. Francis GS, Cohn JN, Johnson G, Rector TS, Goldman S, Simon A. The V-HeFT VA Cooperative Studies Group. Plasma norepinephrine, plasma renin activity, and congestive heart failure. Relations to survival and the effects of therapy in V-HeFT II. Circulation. 1993. 87:Suppl 6. V140–V148.

9. Waagstein F, Bristow MR, Swedberg K, Camerini F, Fowler MB, Silver MA, et al. Beneficial effect of metoprolol in idiopathic dilated cardiomyopathy. Lancet. 1993. 342:1441–1446.

10. CIBIS Investigators and Committees. A randomized trial of B-blockade in heart failure. The Cardiac Insufficiency Bisoprolol study (CIBIS). Circulation. 1994. 90:1765–1773.

11. The Cardiac Insufficiency Bisoprolol Study II (CIBIS-II): a randomised trial. Lancet. 1999. 353:9–13.

12. Hjalmarson A, Goldstein S, Fagerberg B, Wedel H, Waagstein F, Kjekshus J, et al. MERIT-HF Study Group. Effects of controlled-release metoprolol on total mortality, hospitalizations, and well-being in patients with heart failure: the Metoprolol CR/XL Randomized Intervention Trial in congestive heart failure (MERIT-HF). JAMA. 2000. 283:1295–1302.

13. Ghali JK, Piña IL, Gottlieb SS, Deedwania PC, Wikstrand JC. MERIT-HF Study Group. Metoprolol CR/XL in female patients with heart failure: analysis of the experience in metoprolol extended-release randomized intervention trial in heart failure (MERIT-HF). Circulation. 2002. 105:1585–1591.

14. Packer M, Fowler MB, Roecker EB, Coats AJ, Katus HA, Krum H, et al. Effect of carvedilol on the morbidity of patients with severe chronic heart failure: results of the carvedilol prospective randomized cumulative survival (COPERNICUS) study. Circulation. 2002. 106:2194–2199.

15. Rouleau JL, Roecker EB, Tendera M, Mohacsi P, Krum H, Katus HA, et al. Influence of pretreatment systolic blood pressure on the effect of carvedilol in patients with severe chronic heart failure: the Carvedilol Prospective Randomized Cumulative Survival (COPERNICUS) study. J Am Coll Cardiol. 2004. 43:1423–1429.

16. Uddin N, Patterson JH. Current guidelines for treatment of heart failure: 2006 update. Pharmacotherapy. 2007. 12S–17S.

17. Heart Failure Society of America. HFSA guidelines for management of patients with heart failure caused by left ventricular systolic dysfunction-pharmacological approaches. Pharmacotherapy. 2000. 20:495–522.

18. Skinner JS, Cooper A, Feder GS. Guideline Development Group. Secondary prevention for patients following a myocardial infarction: summary of NICE guidance. Heart. 2007. 93:862–864.

19. Dalal H, Evans PH, Campbell JL. Recent developments in secondary prevention and cardiac rehabilitation after acute myocardial infarction. BMJ. 2004. 328:693–697.

20. Go AS, Iribarren C, Chandra M, Lathon PV, Fortmann SP, Quertermous T, et al. Statin and beta-blocker therapy and the initial presentation of coronary heart disease. Ann Intern Med. 2006. 144:229–238.

21. Dargie HJ. Effect of carvedilol on outcome after myocardial infarction in patients with left-ventricular dysfunction: the CAPRICORN randomised trial. Lancet. 2001. 357:1385–1390.

22. Otterstad JE, Ford I. The effect of carvedilol in patients with impaired left ventricular systolic function following an acute myocardial infarction. How do the treatment effects on total mortality and recurrent myocardial infarction in CAPRICORN compare with previous beta-blocker trials? Eur J Heart Fail. 2002. 4:501–506.

23. Doughty RN, Whalley GA, Walsh HA, Gamble GD, López-Sendón J, Sharpe N. CAPRICORN Echo Substudy Investigators. Effects of carvedilol on left ventricular remodeling after acute myocardial infarction: the CAPRICORN Echo Substudy. Circulation. 2004. 109:201–206.

24. McMurray J, Køber L, Robertson M, Dargie H, Colucci W, Lopez-Sendon J, et al. Antiarrhythmic effect of carvedilol after acute myocardial infarction: results of the Carvedilol Post-Infarct Survival Control in Left Ventricular Dysfunction (CAPRICORN) trial. J Am Coll Cardiol. 2005. 45:525–530.

25. Balligand JL. Beta3-Adrenoceptor stimulation on top of beta(1)-adrenoceptor blockade "Stop or Encore?". J Am Coll Cardiol. 2009. 53:1539–1542.

26. Gupta S, Wright HM. Nebivolol: a highly selective beta1-adrenergic receptor blocker that causes vasodilation by increasing nitric oxide. Cardiovasc Ther. 2008. 26:189–202.

27. Erdamar H, Sen N, Tavil Y, Yazici HU, Turfan M, Poyraz F, et al. The effect of nebivolol treatment on oxidative stress and antioxidant status in patients with cardiac syndrome-X. Coron Artery Dis. 2009. 20:238–234.

28. Williams B, Lacy PS, Thom SM, Cruickshank K, Stanton A, Collier D, et al. Differential impact of blood pressure-lowering drugs on central aortic pressure and clinical outcomes: principal results of the Conduit Artery Function Evaluation (CAFE) study. Circulation. 2006. 113:1213–1225.