Mancia Giuseppe, Kjeldsen Sverre E, Kreutz Reinhold, Pathak Atul, Grassi Guido, Esler Murray
University of Milano-Bicocca, Milan, Italy (G.M., G.G.).
Department of Cardiology, University of Oslo, Ullevaal Hospital, Norway (S.E.K.).
Hypertension. 2022 Jun;79(6):1153-1166. doi: 10.1161/HYPERTENSIONAHA.122.19020. Epub 2022 Apr 5.
Several hypertension guidelines have removed beta-blockers from their previous position as first-choice drugs for the treatment of hypertension. However, this downgrading may not be justified by available evidence because beta-blockers lower blood pressure as effectively as other major antihypertensive drugs and have solid documentation in preventing cardiovascular complications. Suspected inconveniences of beta-blockers such as increased risk of depression or erectile dysfunction may have been overemphasized, while patients with chronic obstructive pulmonary disease or peripheral artery disease, that is, conditions in which their use was previously restricted, will benefit from beta-blocker therapy. Besides, evidence that from early to late phases, hypertension is accompanied by activation of the sympathetic nervous system makes beta-blockers pathophysiologically an appropriate treatment in hypertension. Beta-blockers have favorable effects on a variety of clinical conditions that may coexist with hypertension, making their use either as specific treatment or as co-treatment potentially common in clinical practice. Guidelines typically limit recommendations on specific beta-blocker use to cardiac conditions including angina pectoris, postmyocardial infarction, or heart failure, with little or no mention of the additional cardiovascular or noncardiovascular conditions in which these drugs may be needed or preferred. In the present narrative review, we focus on multiple additional diseases and conditions that may occur and affect patients with hypertension, often more frequently than people without hypertension, and that may favor the choice of beta-blocker. Notwithstanding, beta-blockers represent an in-homogenous group of drugs and choosing beta-blockers with documented effect in prevention and treatment of disease is important for first choice in guidelines.
several hypertension guidelines have removed beta-blockers from their previous position as first-choice drugs for the treatment of hypertension. However, this downgrading may not be justified by available evidence because beta-blockers lower blood pressure as effectively as other major antihypertensive drugs and have solid documentation in preventing cardiovascular complications. Suspected inconveniences of beta-blockers such as increased risk of depression or erectile dysfunction may have been overemphasized, while patients with chronic obstructive pulmonary disease or peripheral artery disease, that is, conditions in which their use was previously restricted, will benefit from beta-blocker therapy. Besides, evidence that from early to late phases, hypertension is accompanied by activation of the sympathetic nervous system makes beta-blockers pathophysiologically an appropriate treatment in hypertension. Beta-blockers have favorable effects on a variety of clinical conditions that may coexist with hypertension, making their use either as specific treatment or as co-treatment potentially common in clinical practice. Guidelines typically limit recommendations on specific beta-blocker use to cardiac conditions including angina pectoris, postmyocardial infarction, or heart failure, with little or no mention of the additional cardiovascular or noncardiovascular conditions in which these drugs may be needed or preferred. In the present narrative review, we focus on multiple additional diseases and conditions that may occur and affect patients with hypertension, often more frequently than people without hypertension, and that may favor the choice of beta-blocker. Notwithstanding, beta-blockers represent an in-homogenous group of drugs and choosing beta-blockers with documented effect in prevention and treatment of disease is important for first choice in guidelines.
几种高血压指南已将β受体阻滞剂从其先前作为治疗高血压的首选药物的地位中移除。然而，这种降级可能没有现有证据支持，因为β受体阻滞剂降低血压的效果与其他主要抗高血压药物一样有效，并且在预防心血管并发症方面有确凿的文献记载。β受体阻滞剂的一些潜在不便之处，如抑郁症或勃起功能障碍风险增加，可能被过度强调了，而慢性阻塞性肺疾病或外周动脉疾病患者，即以前限制使用β受体阻滞剂的情况，将从β受体阻滞剂治疗中获益。此外，有证据表明，从早期到晚期，高血压都伴有交感神经系统的激活，这使得β受体阻滞剂在病理生理学上是高血压的一种合适治疗方法。β受体阻滞剂对多种可能与高血压并存的临床情况有有益作用，使其作为特异性治疗或联合治疗在临床实践中可能很常见。指南通常将特定β受体阻滞剂的使用建议限制在包括心绞痛、心肌梗死后或心力衰竭等心脏疾病，很少或根本没有提及这些药物可能需要或更适合的其他心血管或非心血管疾病。在本叙述性综述中，我们关注多种可能发生并影响高血压患者的其他疾病和情况，这些情况在高血压患者中往往比非高血压患者更频繁出现，并且可能有利于β受体阻滞剂的选择。尽管如此，β受体阻滞剂是一类异质性药物，选择在疾病预防和治疗中有文献记载效果的β受体阻滞剂作为指南中的首选很重要。
