title: Cardioselective beta-blocker treatment of hypertension in patients with asthma: when do benefits outweigh risks?
abstract: BACKGROUND
  Benefits outweigh risks of cardioselective beta-blocker therapy in patients with nonsevere asthma and a history of heart failure or myocardial infarction (MI). This review summarizes the risks versus benefits of using cardioselective beta-blockers in the treatment of hypertension in patients with asthma.
  
  
  METHODS
  We searched the English literature from 1976 to 2011 via PubMed, EMBASE, and SCOPUS using the following search terms: "beta-blocker treatment of hypertension" AND "asthma"; "cardioselective beta-blockers" AND "asthma." When pertinent articles were found, we assessed relevant articles cited in those papers. All studies related to cardioselective beta-blocker use in patients with asthma and hypertension were included.
  
  
  RESULTS
  Seven studies with patient populations ranging from 10 to 17 patients evaluated cardioselective beta-blockers in patients with asthma and hypertension. Atenolol and/or immediate-release metoprolol were evaluated in these studies. The duration of beta-blocker therapy in four studies was 1-8 weeks; two studies were single dose and one investigation lasted 8 months. Metoprolol and atenolol were generally well tolerated except at higher doses such as metoprolol >100 mg daily.
  
  
  CONCLUSIONS
  In the absence of concomitant cardiovascular disease, routine use of beta-blockers for the treatment of hypertension in patients with asthma should be avoided.
authors.affiliation: Department of Clinical Pharmacy, University of Tennessee Health Science Center, Methodist University Hospital, Memphis, USA. tself@uthsc.edu
authors.forename: Timothy H
authors.initials: TH
authors.lastname: Self
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Wallace
authors.forename: Judith E
authors.initials: JE
authors.lastname: Soberman
mesh_terms: D058671:Adrenergic beta-1 Receptor Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D001249:Asthma / Q000453:epidemiology*; D001262:Atenolol / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000453:epidemiology*; D008790:Metoprolol / Q000627:therapeutic use; D018570:Risk Assessment
chemical_list: D058671:Adrenergic beta-1 Receptor Antagonists; D001262:Atenolol; D008790:Metoprolol