title: β-blockers: a review of their pharmacological and physiological diversity in hypertension.
abstract: OBJECTIVE
  To review the pharmacology, pharmacokinetics, and pharmacodynamic properties of commonly used β-blockers (atenolol, carvedilol, metoprolol succinate, metoprolol tartrate, and nebivolol).
  
  
  METHODS
  A MEDLINE literature search (1966-May 2013) was performed using the following key terms: hypertension, β-blockers, atenolol, carvedilol, metoprolol tartrate, metoprolol succinate, nebivolol, pharmacology, pharmacodynamics, pharmacokinetics, blood pressure, metabolic, lipid, central aortic pressure, diabetes, and insulin resistance. References from publications reviewed were included.
  
  
  METHODS
  English-language articles identified were reviewed. Animal studies and studies in patients for a primary diagnosis of coronary artery disease were excluded.
  
  
  RESULTS
  β-Blockers are no longer recommended first-line therapy for primary hypertension, based on data showing that β-blockers are inferior to other antihypertensives and no better than placebo, in spite of provision of blood pressure reduction. Because atenolol is the β-blocker used in 75% of these studies, uncertainty about widespread application to all β-blockers exists. Different pharmacological and physiological properties, both within β-blockers and compared with other antihypertensives, may explain divergent effects. Evidence shows that β-blockers have a truncated effect on central aortic pressure, an independent predictor of cardiovascular events, compared with other antihypertensive classes; differences within the class may exist, but the evidence is inconclusive. Metabolic effects differ within the β-blocker class, with evidence that carvedilol causes less metabolic dysregulation.
  
  
  CONCLUSIONS
  Emerging evidence reveals physiological differences within the β-blocker class and in comparison to other antihypertensives. These differences provide insight into the diverse clinical effects β-blockers provide in cardiovascular disease.
authors.affiliation: University of Oklahoma College of Pharmacy, Oklahoma City, OK, USA.
authors.forename: Toni L
authors.initials: TL
authors.lastname: Ripley
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Saseen
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use; D001262:Atenolol / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use; D001578:Benzopyrans / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D002227:Carbazoles / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use; D000077261:Carvedilol; D004983:Ethanolamines / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000378:metabolism; D008790:Metoprolol / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use; D000068577:Nebivolol; D011412:Propanolamines / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use
chemical_list: D000319:Adrenergic beta-Antagonists; D000959:Antihypertensive Agents; D001578:Benzopyrans; D002227:Carbazoles; D004983:Ethanolamines; D011412:Propanolamines; D000068577:Nebivolol; D000077261:Carvedilol; D001262:Atenolol; D008790:Metoprolol
keywords: central aortic pressure; hypertension; metabolic; pharmacodynamics; pharmacology; β-blockers