Beta-blockers and treatment of hypertension

Dr Giuseppe Mancia is an emeritus professor of medicine at the University of Milano-Bicocca (Italy) and past president of the International Society of Hypertension and the European Society of Hypertension.

Is there still a place for beta-blockers in the treatment of hypertension?

Giuseppe Mancia, MD, PhD: There is a very important place. Beta-blockers continue to be retained by the European guidelines as one of the 5 major options for starting and continuing treatment in hypertension.

There are 5 major drug classes that have their “documents” in order, that is, they lower blood pressure effectively and they have evidence from placebo-controlled trials of cardiovascular protection. By and large, when comparison studies have been made, the degree of protection is similar for these 5 drug classes. So all of them—diuretics, angiotensin receptor antagonists, angiotensin-converting enzyme (ACE) inhibitors, calcium channel blockers, but also beta-blockers—have been considered as suitable for the initiation and maintenance of antihypertensive treatment.

Beta-blockers also have specific [indications], for example, patients with previous myocardial infarction or patients with a high heart rate. Whereas for uncomplicated hypertensive patients the preference has been given to blockers of the renin-angiotensin system with a diuretic or with a calcium channel blocker also for pragmatic reasons, as these combinations are available in a single pill format and ranges of doses, which makes titration of effective treatment by physicians more flexible and easier.