Anti-atherosclerotic effects of beta-blockers.

Mechanisms involved in the development of atherosclerosis are reviewed. Based primarily on experimental studies, the following key steps are suggested; (1) endothelial injury; (2) platelet and leukocyte adhesion; (3) smooth muscle proliferation; (4) lipid deposition; (5) arterial tissue hypoxia. Beta-blockers may interfere with (1), (2), (4) and (5), and have been shown to inhibit experimental atherosclerosis, even if given after the disease has been established. Calcium channel and ACE inhibitors interfere with (2), and have been shown to inhibit experimental atherosclerosis if given throughout the experimental period. It is unclear whether the association between hypertension and atherosclerosis is causal. Therefore, antihypertensive agents should be selected according to their potential to interfere with the atherosclerotic process. The primary choice would then be beta-blockers, combined with calcium channel or ACE inhibitors if the patient is considered to be at risk of developing new lesions.