Document Detail


Should beta-blockers still be used as initial antihypertensive agents in uncomplicated hypertension?
MedLine Citation:
PMID:  18071610     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Beta-blockers have long being used as first-line therapy for hypertension as their use had resulted in a reduction in cardiovascular morbidity and mortality in controlled clinical trials. A recent meta-analysis comparing beta-blockers to all other anti-hypertensive drugs taken together has found that stroke reduction was sub-optimal. Specifically, atenolol was associated with a 26% higher risk of stroke compared with other drugs. Several reasons may explain the less favourable outcomes with beta-blocker therapy. These include some adverse metabolic abnormalities such as dyslipidaemia and new-onset diabetes, and less effective reduction of central aortic compared with brachial blood pressure. Newer beta-blockers such as carvedilol or nebivolol are better tolerated. These beta-blockers have a vasodilating effect, which may beneficially affect systolic blood pressure in the aorta. Their long-term cardiovascular outcome in hypertension is still not known. Further studies would be required to show that stroke is adequately reduced by these newer beta-blockers. In conclusion, beta-blockers should not be the first drugs of choice in the management of uncomplicated hypertension. They may be used in addition to other antihypertensive agents to achieve blood pressure goals. However, in patients with angina pectoris, a previous myocardial infarction, heart failure and certain dysrhythmias, beta-blockers still play an important role.
Authors:
Akira Wu
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Annals of the Academy of Medicine, Singapore     Volume:  36     ISSN:  0304-4602     ISO Abbreviation:  Ann. Acad. Med. Singap.     Publication Date:  2007 Nov 
Date Detail:
Created Date:  2007-12-11     Completed Date:  2008-04-29     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7503289     Medline TA:  Ann Acad Med Singapore     Country:  Singapore    
Other Details:
Languages:  eng     Pagination:  962-4     Citation Subset:  IM    
Affiliation:
Diabetes Care Centre, Mount Elizabeth Hospital, Singapore.
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MeSH Terms
Descriptor/Qualifier:
Adrenergic beta-Antagonists / contraindications*,  therapeutic use*
Antihypertensive Agents / contraindications*,  therapeutic use
Humans
Hypertension / drug therapy*
Meta-Analysis as Topic
Singapore
Stroke / chemically induced
Chemical
Reg. No./Substance:
0/Adrenergic beta-Antagonists; 0/Antihypertensive Agents

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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