Selective versus nonselective beta adrenoceptor antagonists in hypertension

The application of cost-effectiveness methodology is particularly important in widespread diseases such as hypertension. However, because prospective cost-effectiveness analyses comparing different antihypertensive drugs are not currently available, differences in the cost effectiveness of these drugs can only be estimated. The purpose of this review is to estimate and compare the costs of drug therapy with selective and nonselective beta adrenoceptor antagonists in hypertension. The global costs of antihypertensive treatment are largely determined by drug costs. In most countries, drug costs do not appear to vary substantially between beta 1-selective and nonselective beta-blockers. The adverse sequelae of hypertension include stroke, myocardial infarction, cardiac hypertrophy and renal failure. There are no obvious differences in effect on stroke and cardiac hypertrophy between beta 1-selective and nonselective beta-blockers. However, compared with beta 1-selective antagonists, nonselective drugs might be less effective in preventing myocardial infarction in smokers and may impair renal function in patients with both increased peripheral resistance and declining cardiac output. There is a clear difference between beta 1-selective and nonselective beta-blockers on quality-of-life (QOL) perception. During treatment with nonselective beta-blockers, QOL perception is lower than during treatment with beta 1-selective drugs. Preservation of quality of life during long term antihypertensive treatment deserves considerable weight in economic analyses. Consequently, the more favourable effects of beta 1-selective agents on quality of life may outweigh the possible higher costs of these drugs, and suggest that beta 1-selective agents may be more cost effective than nonselective beta-blockers.