Beta-blockers and hypertension: carbon copies or a real choice

An extensive, almost overwhelming number of publications attest to the importance of beta-blockers and emphasize their role in a variety of clinical disorders. Despite uncertainty regarding the precise mechanism by which beta-adrenergic blocking drugs lower blood pressure, it is well established that these agents are fairly effective when used alone and are highly effective when combined with diuretics and/or vasodilators. Despite remarkably comparable efficacy, the available beta-blockers possess a variety of properties that may influence the frequency and type of untoward reactions. An approach to individualized choice of beta-blockers is outlined. It must be emphasized that our approach is in large part based on theoretical considerations, and further studies are needed to clearly define the relative likelihood of unwanted effects with each available agent.