Cardiovascular Protection Using Beta-Blockers

Bangalore, Sripal; Messerli, Franz H.; Kostis, John B.; Pepine, Carl J.

doi:10.1016/j.jacc.2007.04.060

Cited by 233Blood Pressure and Hypertension StudiesCardiovascular Health and Disease PreventionClinical practice guidelines implementation

Cardiovascular Protection Using Beta-Blockers

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Bangalore, Sripal, Messerli, Franz H., Kostis, John B., Pepine, Carl J.·2007·Journal of the American College of Cardiology

DOI 10.1016/j.jacc.2007.04.060

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Abstract

For more than 3 decades, beta-blockers have been widely used in the treatment of hypertension and are still recommended as first-line agents by national and international guidelines. Recent meta-analyses indicate that, in patients with uncomplicated hypertension, compared with other antihypertensive agents, first-line therapy with beta-blockers was associated with an increased risk of stroke, especially in the elderly cohort with no benefit for the end points of all-cause mortality, cardiovascular morbidity, and mortality. In this review, we critically analyze the evidence supporting the use of beta-blockers in patients with hypertension and evaluate evidence for its role in other indications. The review of the currently available literature shows that in patients with uncomplicated hypertension, there is a paucity of data or absence of evidence to support use of beta-blockers as monotherapy or as first-line agents. Given the increased risk of stroke, their "pseudo-antihypertensive" efficacy (failure to lower central aortic pressure), lack of effect on regression of target end organ effects like left ventricular hypertrophy and endothelial dysfunction, and numerous adverse effects, the risk benefit ratio for beta-blockers is not acceptable for this indication. However, beta-blockers remain very efficacious agents for the treatment of heart failure, certain types of arrhythmia, hypertropic obstructive cardiomyopathy, and in patients with prior myocardial infarction.

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Clinical trial evidence is that β-adrenergic blocking drugs have been less beneficial in hypertension than anticipated.
“Clinical trial evidence is that β-adrenergic blocking drugs have been less beneficial in hypertension than anticipated.106”
From Obesity Paradox in Hypertension: Is This Because Sympathetic Activation in Obesity-Hypertension Takes a Benign Form? (2018) · cites this paper as [106]

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Authors: Bangalore, S., Messerli, F. H., Kostis, J. B., & Pepine, C. J.
Affiliations: St. Luke's-Roosevelt Hospital Center (US)
University of Medicine and Dentistry of New Jersey (US)
University of Florida Health (US)
Corresponding author: Messerli, Franz H.
ORCID: Bangalore, Sripal
Messerli, Franz H.
Pepine, Carl J.
Venue: Journal of the American College of Cardiology
Publisher: Elsevier BV
Published: 2007-08
Volume: 50
Issue: 7
Pages: 563-572
ISSN: 0735-1097 (ISSN-L)
DOI: 10.1016/j.jacc.2007.04.060
OpenAlex: W165973742
Cited by: 233
References: 104
Citations by year: 2026: 3 · 2025: 7 · 2024: 7 · 2023: 7 · 2022: 6 · 2021: 12 · 2020: 5 · 2019: 8 · 2018: 9 · 2017: 4 · 2016: 10 · 2015: 16 · 2014: 12 · 2013: 15 · 2012: 14
FWCI: 3.23
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/open-access/userlicense/1.0/ (vor, 2213 d)
Locations: Journal of the American College of Cardiology (publishedVersion)
PubMed (publishedVersion)
Funders: Abbott Laboratories
Bristol-Myers Squibb
Pfizer
GlaxoSmithKline
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
Keywords: beta-blockers, hypertension, first-line antihypertensive therapy, stroke risk, cardioprotection, heart failure, cardiac arrhythmias, hypertrophic obstructive cardiomyopathy, myocardial infarction, left ventricular hypertrophy, endothelial dysfunction, adverse effects, risk-benefit ratio
MeSH terms: Adrenergic beta-Antagonists, Heart Diseases, Humans, Hypertension, Risk Assessment

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Cardiovascular Protection Using Beta-Blockers

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