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Beta-Blockers and Hypertension: Some Questions and Answers

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Abstract

Introduction

International guidelines have removed b-blockers from first-line treatment of hypertension, limiting their use to patients with compelling indications. The position of guidelines stems from the results of studies performed with the 1st and 2nd generation of b-blockers, which concluded that these drugs have lower cardiovascular protection, compared with other antihypertensive agents.

Aim

The aim of our mini review is to answer to some questions about the effect of b-blockers on hypertension and cardiovascular protection and if these effects are different from those of other antihypertensive drugs, particularly in young and elderly patients.

Methods

We evaluated the relevant systematic reviews and meta-analyses, which reported the effectiveness of b-blockers on blood pressure and cardiovascular outcomes, compared with placebo/no treatment and with other antihypertensive agents.

Results

Beta-blockers, decreased high blood pressure with no significant difference from other common antihypertensive agents. Moreover b-blockers, compared with placebo, lowered the risk of major cardiovascular outcomes, while, compared with other drug classes, the reported results are very heterogeneous. Therefore it is difficult, globally, to find a difference between b-blockers and other drug classes.

Conclusions

Rather than looking for differences in the cardiovascular protective effect between b-blockers and other antihypertensive agents, we have to consider the different pathophysiology of hypertension in young [sympathetic hyperactivity] and elderly patients [arterial stiffness, high aortic systolic pressure]. Considering these aspects, non-vasodilating b-blockers are preferred, as first-line, in young/middle aged hypertensive subjects, while vasodilating b-blockers, are most appropriate, in elderly patients, for the favourable hemodynamic profile.

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Data sharing not applicable—no new data generated.

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Authors and Affiliations

  1. Department of Cardiovascular Risk, Salamanca University, Salamanca, Spain

    Francesco Fici

  2. Milano-Bicocca University, Milan, Italy

    Francesco Fici

  3. University Hospital, of Badajoz, Badajoz, Spain

    Nicolas Roberto Robles

  4. Cardiology and Hypertension Department, Medical Park Hospital, Izmir University, Izmir, Turkey

    Istemihan Tengiz

  5. Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy

    Guido Grassi

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  1. Francesco Fici
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Correspondence to Nicolas Roberto Robles.

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Fici, F., Robles, N.R., Tengiz, I. et al. Beta-Blockers and Hypertension: Some Questions and Answers. High Blood Press Cardiovasc Prev 30, 191–198 (2023). https://doi.org/10.1007/s40292-023-00576-3

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