Optimizing antihypertensive treatment in clinical practice

Hypertension affects approximately 50 million individuals in the United States (US) and approximately 1 billion individuals worldwide. Blood pressure (BP) reduction significantly lowers the risk of cardiovascular (CV) disease-the most common cause of death in the US-yet only approximately one third of Americans with hypertension have their disease controlled to the minimum recommended level of <140/90 mm Hg. Clinical trials such as the Hypertension Optimal Treatment (HOT) study, and Treatment of Mild Hypertension Study (TOMHS) have shown that control of BP to targets of < or =140/90 mm Hg reduces the likelihood of CV disease and improves quality of life. This appears to be true even in patients at high risk, such as those with diabetes. Furthermore, it has become increasingly recognized that multiple BP-lowering agents are usually necessary to achieve BP control (<140/90 mm Hg, or <130/80 mm Hg for patients with diabetes or chronic kidney disease). In fact, current hypertension guidelines clearly state that most hypertensive patients will require two or more agents, and recommend initiating treatment with two antihypertensive medications if the BP is >20/10 mm Hg above goal BP. A valuable class of drug in the management of hypertension, beta-blockers (betaB) play an important role-whether as initial agents or as add-on therapy. They are especially useful in hypertensive patients with certain comorbidities such as diabetes or heart failure, in patients post-myocardial infarction, or in those generally at high risk for coronary disease. This article explores the cardioprotective role of how betaB may be used to optimize antihypertensive treatment.