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Doaa M. Hasan* and Islam Kamal


Sustained elevated blood pressure, unresponsive to lifestyle measures, leads to a critically important clinical question: What class of drug to use first-line? β-Blockers are no longer recommended first-line therapy for primary hypertension, based on data showing that β-blockers are inferior to other antihypertensive and no better than placebo, in spite of provision of blood pressure reduction. However, they still widely used on regular bases may be due to their economic value or just lack of clinical update of guide lines. Emerging evidence reveals physiological differences within the β-blocker class and in comparison to other antihypertensive. These differences provide insight into the diverse clinical effects β-blockers provide in cardiovascular disease. It is important for clinicians to recognize that the recommendation to relegate β-blockers, as a class, to add-on therapy in primary hypertension is largely based on evidence from atenolol. Meritorious arguments can be made that the diversity within β-blockers should limit classwide recommendations. Yet using β-blockers as add-on therapy remains an appropriate recommendation in the absence of long-term trials showing benefit with other β-blockers.

Keywords: Hypertension - Beta blockers - antihypertensive drug - international guidelines.

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