Beta-blockers in hypertensive and coronary heart disease.

Beta-Blockers are widely used in cardiovascular medicine. In patients with hypertension, beta-blockers show beneficial effects on clinical end points of stroke and coronary heart disease prevention and mortality. beta-blockers also are well established in improving exercise tolerance and decreasing the number and duration of anginal attacks in patients with angina pectoris. Based on evidence showing reduced mortality and morbidity, beta-blockers are the cornerstone of therapy after acute myocardial infarction. Unfortunately, presumption of poor tolerance has left these drugs underutilized in this clinical setting, despite data that indicate a wide range of tolerability. The use of beta-blockers in patients with congestive heart failure results in beneficial hemodynamic effects and symptomatic improvement. Among factors that should be considered when selecting a beta-blocker for an individual patient are demonstrated efficacy of the drug in a specific indication, tolerability, product formulation and duration of action, and the presence or absence of specific properties such as cardioselectivity.