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Beta-blockers for hypertension: Are they going out of style?
Cleveland Clinic Journal of Medicine, 09/03/09

Che QI et al. – Although beta–blockers lower blood pressure in most patients, the outcomes of clinical hypertension trials of these drugs have been disappointing, and the value of beta–blockers in treating hypertensive patients who do not have compelling indications for them has been questioned. Until these drugs are proved beneficial, they should be used as antihypertensive therapy only in patients with compelling cardiac indications for them or as add–on agents in those with uncontrolled or resistant hypertension.

No evidence exists that beta–blockers prevent first episodes of cardiovascular events in patients with hypertension, and in some trials, outcomes were worse with beta–blockers than with antihypertensive drugs of other classes.
Younger hypertensive patients have hemodynamic characteristics that would seem to be amenable to beta–blocker therapy. However, most clinical trials of beta blockers did not stratify patients by age.
Most trials of the antihypertensive effects of beta–blockers used atenolol (Tenormin), which is not an ideal representative of this class of drugs.
Newer beta–blockers with vasodilatory properties may overcome the adverse effect of increased peripheral vascular resistance that occurs with older agents such as atenolol.

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