The Beta-blocker chronicle: From past principles to present practice - Implications for the Indian subcontinent

β-blockers have evolved from being foundational cardiovascular agents to precision therapies across diverse clinical scenarios. Their journey from early non-selective to β1-selective and vasodilatory molecules reflects advances in understanding adrenergic modulation in cardiovascular continuum. β-blockers remain integral in managing hypertension, chronic coronary syndromes, arrhythmias, and heart failure. Their pharmacodynamic attributes such as β1-selectivity, inverse agonism, sympathoinhibition, and vasodilation allow personalized use in patients with comorbidities like diabetes, asthma or chronic kidney disease. Among contemporary agents, bisoprolol and nebivolol exemplify next generation β-blockers with high β1-selectivity, favourable tolerability, and cardioprotective effects beyond blood pressure and heart rate control. Global and national guidelines recommend them for angina relief, secondary prevention post-MI, and rate control in tachyarrhythmias. In Indian context, prescribing trends highlight bisoprolol among the most prescribed β-blockers, reflecting its clinical trust and relevance. Regional experiences affirm the value of β-blockers in optimizing cardiovascular outcomes across the Indian subcontinent.