Combination Therapy With Beta-Blockers and Angiotensin-Converting Enzyme Inhibitors for Cardiovascular Diseases:...

Patients with hypertension, especially when complicated by cardiovascular disease (CVD) and/or comorbidities, require long-term treatment with a combination of antihypertensive drugs, which often gives rise to complex drug regimens. Dual-agent combination antihypertensive therapy is recommended in most patients with hypertension, and where available, a fixed-dose single-pill combination (SPC) is recommended. The combination of antihypertensive drugs should take into account the patient's overall CVD risk profile (other CVD risk factors and diagnoses). The combination of a beta-blocker and angiotensin-converting enzyme inhibitor (ACEi) acts on two neuroendocrine systems implicated in the pathophysiology of hypertension and multiple CVD: beta-blockers on the sympathetic nervous system and ACEis on the renin-angiotensin system (RAS). A large body of solid evidence states that, in addition to their antihypertensive effects, both beta-blockers and ACEis provide cardioprotection and guarantee reductions in CV morbidity and mortality in patients with coronary artery disease (CAD), atrial fibrillation, and heart failure. For these reasons, such a combination might be beneficial for many patients. This review summarizes the evidence supporting the use of beta-blockers and ACEis, as well as the rationale behind their combined administration, particularly in patients with a high risk of CVD, such as those with ischemic heart disease, atrial fibrillation, or heart failure.