Celiprolol and risk factor reversal in hypertension

beta-Blockers reduce hypertension effectively and safely. However, their overall efficacy is a balance between their influence on blood pressure and their influence on other important risk factors. Thus, whereas a drug may ameliorate the primary blood pressure marker of the syndrome, this effect may be negated by enhancement of aggressive cofactors. The evolution of the beta-blockers exemplifies how this potentially dangerous conflict may be counteracted. The latest "third-generation" agents, such as celiprolol, not only achieve their primary objective of lowering blood pressure, but also have the potential to simultaneously reverse some of the deleterious cofactors. For example, celiprolol reduces the threat of atheroma by lowering serum cholesterol, and enhances the efficacy of myocardial oxygen utilization in heart failure by reducing plasma triglyceride metabolism. Its ability to reduce fibrinogen and its lack of effect on glucose metabolism are additional positive factors. Celiprolol also provides the combined pharmacodynamic advantages of vasodilatation and inotropic support of the heart, and it attenuates the myocardial oxygen-wasting effects of sympathoadrenal stimulation. These attributes all make a positive contribution to cardiovascular risk reversal in the hypertensive patient.