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State-of-the-Art Review: β-Blockade and the Treatment of Hypertension

  • Section 1A: Hypertension
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Summary

The last few years have seen increasingly clear evidence appear that the treatment of mild uncomplicated hypertension can prevent the development of a variety of hypertension-related cardiovascular complications. A good case can now be made for preventive antihypertensive therapy in adults with casual Vth phase diastolic pressures of 95mm Hg or more. This realisation has produced a corresponding requirement for drugs with few side effects; agents such as guanethidine, reserpine, methyldopa and clonidine are less readily accepted in this context. Although neither β-blochers nor thiazides are free from unwanted effects, they most nearly answer these needs and the majority of physicians now employ them as initial therapy.

Preventive antihypertensive treatment has most clearly been successful in preventing strokes, cardiac failure and renal failure; deaths from coronary heart disease, though associated with hypertension, have not notably been reduced by effective antihypertensive treatment. Thiazides, which reduce plasma and total body potassium, can predispose to arrhythmias, and have thus come under suspicion of having a partially adverse effect when used to lower blood pressure. β-Blockers, by contrast, have several actions which should be cardioprotective, and there is now definite evidence of their beneficial effect when given after a myocardial infarction. There are also strong hints that β-blockers have a primary preventive effect, limiting deaths from coronary heart disease, when used to treat hypertension, but firm proof of this is still needed. Thus, β-blockers are increasingly supplanting thiazides as initial antihypertensive therapy.

The mode of action of β-blockers in lowering blood pressure remains controversial. Suppression of renin secretion and reduction of cardiac output have for example been considered, but do not provide full satisfactory explanations. A more recent suggestion, supported by experimental evidence, is that β-blockers prevent adrenaline acting on pre-junctional β-receptors, and so diminish release of neurotransmitter.

It is probable that β-blockers will be the mainstay of antihypertensive therapy for the 1980s.

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  1. Medical Research Council, Blood Pressure Unit, Western Infirmary, Glasgow, G11 6NT, Scotland

    J. I. S. Robertson

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Robertson, J.I.S. State-of-the-Art Review: β-Blockade and the Treatment of Hypertension. Drugs 25 (Suppl 2), 5–11 (1983). https://doi.org/10.2165/00003495-198300252-00003

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