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Debate - Part 2

Beta Blockers are Good Choice as First line Antihypertensive Agents

Volume 2, Apr 2013

Gurmukh S Sainani, MD, Nihar P Mehta, MD, DNB (Medicine), Mumbai India

Beta blockers are in use for more than 3 decades in the treatment of hypertension and are still recommended as first line agents by some of the national and international guidelines. Since beta blockers are heterogenous class of agents with diverse pharmacologic properties, the unfavorable data revealed in the recent meta-analysis is from studies involving the traditional beta blockers (propranalol, atenolol) which are non vasodilating. The vasodilating beta blockers (carvedilol, nebivolol, bisoprolol) reduce blood pressure though reduction of systemic vascular resistance rather than decreasing cardiac output as is seen with traditional beta blockers.

Traditional beta blockers have adverse effects on metabolic and lipid parameters whereas vasodilating beta blockers have neutral or beneficial effects on metabolic and lipid parameters. Vasodilator beta blockers lower BP to a similar degree as other antihypertensive drugs. They also provide better central aortic pressure reduction than traditional beta blockers.

It is unlikely that there will be a single first line drug for hypertensives as most patients will eventually require multiple drugs to control their blood pressure. The choice of treatment will be influenced by associated co-morbidities, underlying cardiovascular risk factors, age of the patient and potential adverse effects. (J Clin Prev Cardiol. 2013;2(2):101-5)
Keywords: Beta blockers, Hypertension

Volume 2, Number 2, Pages: 101-5


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