Should beta blockers no longer be considered first-line therapy for the treatment of essential hypertension without comorbidities?

摘要

Although most guidelines committees historically recommended initial diuretics and/or beta 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 beta blocker. Several meta-analyses have suggested that despite lowering blood pressure, any and all beta 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 beta blocker in hypertensive patients, indirect comparisons can be done with network and Bayesian meta-analyses, which suggest that heterogeneity of beta-blockers' pharmacology also extends to outcomes. Although once-daily atenolol as initial antihypertensive therapy may be unwise, whether initial beta blockers newer than atenolol reduce cardiovascular risk to the same extent as other antihypertensive drugs should be answered with more clinical trials.