Current and future status of beta-blockers in the treatment of hypertension.

Beta-adrenergic receptor blockers (beta-blockers) are effective and safe antihypertensive drugs, and have been recommended as first-line therapy for hypertension by all Joint National Committees (JNCs) for the prevention, detection, evaluation, and treatment of high blood pressure (BP) from the first to the last (JNC-7) in 2003. However, recently questions have been raised by several investigators regarding the antihypertensive effectiveness and safety of these drugs. The Medline literature on this subject was searched and pertinent studies were retrieved. Other pertinent references from existing publications were retrieved and analyzed up to 2007. Additionally, a historical perspective on the discovery of beta-blockers and their mechanism of action is given. Most of the reviewed short-term and long-term clinical trials demonstrate an effective and safe antihypertensive pattern for the beta-blockers. The weaknesses identified include the adverse effect of older beta-blockers on glucose control and stroke protection, especially in older persons. These adverse effects are attributed to their mechanism of action and BP effectiveness. On the basis of the evidence presented, beta-blockers are effective and safe antihypertensive drugs and should still be recommended as first-line therapy in most uncomplicated hypertensive patients, either alone or in combination with other drugs. There are reservations regarding their administration to diabetic and older hypertensive patients. However, when compelling indications for their use exist, they should not be withheld.