Review of state-of-the-art beta-blocker therapy

Beta-adrenoceptor blocking drugs have been used in the treatment of hypertension for more than 2 decades. During this time they have reached the position of first-line therapy for hypertension and are recommended as such by the Joint National Committee (U.S.A.) in 1988 and by the World Health Organization/International Society of Hypertension in 1983 and 1989. This is because of the favorable relationship between the antihypertensive efficacy of these drugs and the rate and severity of their adverse effects. Of particular interest is the possibility that beta blockers may protect against coronary artery disease (CAD). With regard to secondary prevention against CAD, statistically highly significant and clinically relevant reductions of mortality and the risk of reinfarction have been shown in prospective, double-blind, placebo-controlled trials. A primary preventive effect against CAD, on the other hand, has only been shown in open trials without placebo control. However, in spite of the lack of clear proof, this effect still appears to be a logical possibility. Some new findings with beta blockers appear to be of particular interest: beta blockade may reduce myocardial necrosis in patients with marked elevations of plasma catecholamines due to traumatic head injury; a similar protective effect in other situations of severe stress, e.g., acute myocardial infarction, would be of great clinical value. Experimental studies also suggest that beta blockers may have antiatherosclerotic effect in animals fed an atherogenic diet and subjected to stress. Again, clinical confirmation of such results would be of great significance.