title: 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.
authors: Preventive Medicine, Internal Medicine and Pharmacology, Division of Pharmacology, Pacific Northwest University of Health Sciences, Yakima, WA 98901, USA. wj.elliott@yahoo.com
authors: William J
authors: WJ
authors: Elliott
authors: W Kurtis
authors: WK
authors: Childers
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001262:Atenolol / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects*; D002318:Cardiovascular Diseases / Q000188:drug therapy* / Q000209:etiology; D015897:Comorbidity; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D015201:Meta-Analysis as Topic; D017410:Practice Guidelines as Topic
chemical_list: D000319:Adrenergic beta-Antagonists; D000959:Antihypertensive Agents; D001262:Atenolol