Current status of β-blockers for the treatment of hypertension: an update

β-Adrenoceptor blockers (β-blockers) are one of the oldest classes of cardiovascular drugs still in use. Several short- and long-term clinical outcomes studies have demonstrated their effectiveness and safety for the treatment of hypertension, coronary artery disease, myocardial infarction, heart failure and sudden cardiac death. Due to their safety and efficacy, β-blockers have been recommended by several national and international committees as first-line therapy of hypertension. However, despite their proven benefits, their use as first-line treatment for hypertension has come under criticism lately. Because of these recent developments, several authors have recommended that β-blockers no longer be used as first-line therapy for hypertension. In this review, evidence-based information will be presented, which will demonstrate that β-blockers are an effective and safe class of antihypertensive and cardiovascular drugs for most patients with the exception of black and elderly hypertensive patients in whom the β-blockers are less effective compared to other classes of drugs. In addition, evidence will be presented from several major meta-analyses that β-blockers are equally effective in reducing blood pressure and cardiovascular complications. This review will also discuss differences in the mechanism of action of older and newer (third-generation) β-blockers and provide evidence that newer agents should be preferred over the older ones in the treatment of hypertensive patients with certain comorbidities.