Pharmacologic considerations in the positioning of beta-blockers in antihypertensive therapy.

Beta-blockers have been used to treat hypertension for decades, either as monotherapy or combined with other antihypertensive agents, primarily diuretics, often as fixed-dose combination products. Although beta-blockers can lower blood pressure in most patients, outcomes data with these drugs have been disappointing and their value for patients without "compelling indications" has been questioned recently. The early beta-blockers had significant pharmacologic shortcomings; however, later-generation beta-blockers have distinctive and presumably better pharmacologic profiles. The most recently introduced drugs, the vasodilating beta-blockers carvedilol and nebivolol, are now being broadly evaluated as to their efficacy and tolerability in clinical practice.