Magazine article Drug Topics

There's a New School of Thought on Use of Beta-Blockers for Hypertension

Magazine article Drug Topics

There's a New School of Thought on Use of Beta-Blockers for Hypertension

Article excerpt

Beta-blockers have long been a staple in the treatment of hypertension (HTN), but now that may be shifting as several clinical trials show they didn't fare as well in improving cardiovascular outcomes as other classes of drugs. Despite their proven benefit in certain clinical situations, when it comes to the treatment of uncomplicated hypertension, there may be better choices, the experts say. In addition, newer beta-blockers with vasodilatory effects may be more beneficial than their older counterparts.

One compelling reason for the emergence of questions surrounding the value of beta-blockers (BBs) is the data coming from two studies in particular, explained Michael A. Weber, M.D., professor of medicine at SUNY Downstate Medical Center in Brooklyn, N.Y. "The two most obvious are the Losartan Intervention for Endpoint Reduction (LIFE) study and the Angio-Scandinavian Cardiac Outcomes (ASCOT) trial in which beta-blockers were compared with other types of antihypertensives. The event rates- both fatal and non-fatal outcomes-seem to be higher in patients taking the beta-blocker," he told Drug Topics. "Particularly for endpoints like stroke and mortality, the BBs just didn't seem to be quite matching up."

In addition to study results, Weber explained that what has happened over the past few years with the advent of newer and safer drugs to treat HTN, such as angiotensin converting enzyme inhibitors (ACEIs), angiotensin II receptor blockers (ARBs), and the newer calcium channel blockers (CCBs), is that physicians and patients alike don't want to use drugs with adverse effects. He explained diat the BBs can cause lethargy and negatively affect both exercise performance and sexual function, in addition to negative effects on metabolic measurements, including the lipid profile and blood glucose levels. "There seems to be almost a list of reasons why we might want to be cautious with beta-blockers," he said.

What Weber and his colleagues believe, and published in a recent issue of the Journal of Clinical Hypertension, is that the newer BBs, such as carvedilol and nebivolol (Bystolic, Mylan/Bertek), are quite different from traditional BBs due to their vasodilatory effects. He explained that, while the older BBs tend to reduce blood pressure by reducing cardiac output, they also cause peripheral resistance. "They do lower blood pressure, but it's mainly due to decreased cardiac output rather than attacking the real root of the problem, which is the vasoconstriction. …

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