Some national guidelines on hypertension have demoted beta-blockers from a first-choice to a fourth-choice treatment. In contrast, the 2007 guidelines of the European Society of Hypertension/European Society of Cardiology (ESH/ESC) retain them among the drug classes used to initiate and maintain antihypertensive treatment, together with diuretics, angiotensin-converting enzyme (ACE)-inhibitors, calcium antagonists, and angiotensin receptor antagonists. The reasons are as follows. First, in most trials beta-blockers were used with thiazide diuretics, making it illogical to drop one and save the other. Secondly, individual trials and meta-analyses conflict regarding whether beta-blockers are less effective in preventing cardiovascular events than other drugs. Thirdly, a reduced protective effect of beta-blockers against stroke has been reported in some but not all trials; blood pressure reduction per se is probably the most important factor in protecting patients against stroke. Rationally, therefore, it seems appropriate for the ESH/ESC guidelines to recommend that no available drug class should be generically prescribed or proscribed. Beta-blockers should be avoided in patients with a high risk of incident diabetes, and in those with contraindications. However, they remain drugs of crucial importance in other common clinical situations, e.g. in hypertensive patients with angina pectoris, post-myocardial infarction, and heart failure. © The Author 2009.

Mancia, G. (2009). Prevention of risk factors: Beta-blockade and hypertension. EUROPEAN HEART JOURNAL SUPPLEMENTS, 11(A), A3-A8 [10.1093/eurheartj/sup003].

Prevention of risk factors: Beta-blockade and hypertension

MANCIA, GIUSEPPE
2009

Abstract

Some national guidelines on hypertension have demoted beta-blockers from a first-choice to a fourth-choice treatment. In contrast, the 2007 guidelines of the European Society of Hypertension/European Society of Cardiology (ESH/ESC) retain them among the drug classes used to initiate and maintain antihypertensive treatment, together with diuretics, angiotensin-converting enzyme (ACE)-inhibitors, calcium antagonists, and angiotensin receptor antagonists. The reasons are as follows. First, in most trials beta-blockers were used with thiazide diuretics, making it illogical to drop one and save the other. Secondly, individual trials and meta-analyses conflict regarding whether beta-blockers are less effective in preventing cardiovascular events than other drugs. Thirdly, a reduced protective effect of beta-blockers against stroke has been reported in some but not all trials; blood pressure reduction per se is probably the most important factor in protecting patients against stroke. Rationally, therefore, it seems appropriate for the ESH/ESC guidelines to recommend that no available drug class should be generically prescribed or proscribed. Beta-blockers should be avoided in patients with a high risk of incident diabetes, and in those with contraindications. However, they remain drugs of crucial importance in other common clinical situations, e.g. in hypertensive patients with angina pectoris, post-myocardial infarction, and heart failure. © The Author 2009.
Articolo in rivista - Articolo scientifico
Arterial Hypertension, Drugs therapy, prevention CV risk
English
2009
11
A
A3
A8
none
Mancia, G. (2009). Prevention of risk factors: Beta-blockade and hypertension. EUROPEAN HEART JOURNAL SUPPLEMENTS, 11(A), A3-A8 [10.1093/eurheartj/sup003].
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/10281/9950
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