title: The role of Beta-blockers as first-line therapy in hypertension.
abstract: National and international guidelines still recommend β-blockers (BBs) as first-line agents in uncomplicated prevention of hypertension. However, it has been shown that BBs reduce blood pressure less than other drugs, specifically with regard to central aortic pressure. More importantly, recent meta-analyses have highlighted that in primary prevention BBs are associated with a relatively weak effect in reducing stroke compared to placebo or no treatment and, compared with other drugs, show evidence of a worse cardiovascular outcome. Several reasons might explain their mild cardioprotective effect, such as their unfavorable metabolic properties, a lack of efficacy on left ventricular hypertrophy regression and endothelial dysfunction, and reduced patient compliance. Thus, the available evidence does not support the use of BBs as first-line drugs in the treatment of uncomplicated hypertension. It remains to be determined whether newer BBs, such as nebivolol and carvedilol, will be more effective than older compounds in improving cardiovascular prognosis.
authors.affiliation: Institute of Cardiology, Catholic University of the Sacred Heart, Policlinico A. Gemelli, Largo A. Gemelli, 8, 00168, Rome, Italy. adecatro@yahoo.it
authors.forename: Alberto Ranieri
authors.initials: AR
authors.lastname: De Caterina
authors.forename: Antonio Maria
authors.initials: AM
authors.lastname: Leone
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage*; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D001578:Benzopyrans / Q000008:administration & dosage; D001795:Blood Pressure Determination; D002227:Carbazoles / Q000008:administration & dosage; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000517:prevention & control*; D000077261:Carvedilol; D004983:Ethanolamines / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D015994:Incidence; D008875:Middle Aged; D000068577:Nebivolol; D011322:Primary Prevention / Q000379:methods; D011412:Propanolamines / Q000008:administration & dosage; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists; D000959:Antihypertensive Agents; D001578:Benzopyrans; D002227:Carbazoles; D004983:Ethanolamines; D011412:Propanolamines; D000068577:Nebivolol; D000077261:Carvedilol