Beta-adrenergic receptor blocking drugs in hypertension. With special reference to their use as initial therapy

Beta-adrenergic receptor blocking agents have been receiving attention as first-line agents for the treatment of hypertension. However, a number of significant side effects of these drugs have been brought to light. The most important of these--increases in "atherogenic" lipid concentrations--may place treated persons at risk of coronary artery disease and myocardial infarction. Other side effects, including bronchospasm, heart failure, cold extremities, reduced insulin secretion and central nervous system effects, may preclude their use in many patients. However, because several major trials have shown that controlling blood pressure reduces the incidence of coronary heart disease and stroke, the use of antihypertensive therapy is likely to increase and to continue for longer periods. The physician must prescribe an agent with the fewest and most minor side effects. Alternatives to beta-blocking drugs, such as the alpha-receptor blocking agent prazosin, should be considered and evaluated because of the limiting side effect profile of beta blockers.