Therapeutic Role of Beta-blockers in Hypertension: A Pragmatic Reappraisal

Beta-blockers have been used as first-time antihypertensives for decades and such use has also been recommended by guidelines. However, subsequently some meta-analyses questioned this status of beta-blockers by bringing to light their limitation in terms of stroke prevention and their metabolic sideeffects. Following this, several major international hypertension guidelines have removed beta-blockers from the first line of recommended drugs. Some other guidelines, however, have retained them as first-line antihypertensive. Age is an important determinant of choice of antihypertensives and beta-blockers have proven to be very useful in young hypertensives especially if overweight. Amidst these controversies, vasodilatory beta-blockers have emerged with a new promise. They are potent antihypertensives with better reduction of central aortic pressure and a neutral or favorable metabolic profile.