Prevention of risk factors: Beta-blockade and hypertension

Giuseppe Mancia

Research output: Contribution to journalArticlepeer-review


Some national guidelines on hypertension have demoted beta-blockers from a first-choice to a fourth-choice treatment. In contrast, the 2007 guidelines of the European Society of Hypertension/European Society of Cardiology (ESH/ESC) retain them among the drug classes used to initiate and maintain antihypertensive treatment, together with diuretics, angiotensin-converting enzyme (ACE)-inhibitors, calcium antagonists, and angiotensin receptor antagonists. The reasons are as follows. First, in most trials beta-blockers were used with thiazide diuretics, making it illogical to drop one and save the other. Secondly, individual trials and meta-analyses conflict regarding whether beta-blockers are less effective in preventing cardiovascular events than other drugs. Thirdly, a reduced protective effect of beta-blockers against stroke has been reported in some but not all trials; blood pressure reduction per se is probably the most important factor in protecting patients against stroke. Rationally, therefore, it seems appropriate for the ESH/ESC guidelines to recommend that no available drug class should be generically prescribed or proscribed. Beta-blockers should be avoided in patients with a high risk of incident diabetes, and in those with contraindications. However, they remain drugs of crucial importance in other common clinical situations, e.g. in hypertensive patients with angina pectoris, post-myocardial infarction, and heart failure.

Original languageEnglish
JournalEuropean Heart Journal, Supplement
Issue numberA
Publication statusPublished - 2009


  • Antihypertensive agents
  • Beta-blockers
  • Clinical trials
  • Coronary artery disease
  • Evidence-based medicine
  • Guidelines
  • Hypertension
  • Ischaemic heart disease

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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