Beta-blockers in hypertension.

Following the early and important observations more than two decades ago, by Prichard and Gillam that beta-blockers had a useful antihypertensive effect, this class of compounds has become widely accepted in the treatment of elevated arterial pressure. Today there are numerous different compounds available within the beta-blocker class, with marked differences in their ancillary properties. Undoubtedly, the blockade of beta 1-adrenoceptors is the effect needed to achieve the reduction in blood pressure, and this selectivity also offers some advantages from a safety point of view. However, in some circumstances, ancillary properties such as beta 2-blockade may offer advantages, as can intrinsic sympathomimetic activity. The fact that beta-blockers have become first-line treatment for hypertension in many countries and that memoranda produced by the World Health Organization and the International Society of Hypertension jointly advocate beta-blockers as one alternative for basic therapy reflects the positive balance between efficacy and side effects seen with these agents. It is also an indication that positive long-term clinical experience has been accumulated with beta-blockers. Finally, secondary prevention against coronary heart disease is well documented for beta-blockers. For this reason there have been great hopes for many years that beta-blockers would also have a primary preventive effect against coronary heart disease when used in the treatment of hypertension. Indications are now accumulating that, at least in some subgroups of patients, beta-blockers may have such an effect. Thus, although newer classes of compounds appear to be extremely competitive, beta-blockers are likely to play an important role in the treatment of hypertension for many years to come.