Beta-blockers no longer first line for simple hypertension

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Beta-blockers no longer first line for simple hypertension

Initiating treatment of hypertension with beta-blockers leads to modest CVD reductions and little or no effects on mortality (atenolol mainly studied). These beta-blocker effects are inferior to those of other antihypertensive drugs.1,2 In addition, there was an increase in stroke in beta-blockers compared to calcium channel blockers  (RR 1.24, 95% CI 1.11 to 1.40; moderate-certainty evidence) and renin angiotensin inhibitors (RR 1.30, 95% CI 1.11 to 1.53; moderate-certainty evidence). Compared with placebo there was a reduction in stroke.

 The role of beta-blockers is now for heart rate slowing in tachyarrythmias, post myocardial infarct (and only for one year if no heart failure exists) and congestive heart failure and as a 4th or 5th line blood pressure lowering medication.  Atenolol is no longer the beta-blocker of choice. 

A good alternative to metoprolol succinate is bisoprolol, which is also cardioselective and is once daily dosing, and has a simpler four step dosing range to the maximum dose of 10 mg.3 


  1. Wiysonge CS, et al. Beta-blockers for hypertension. Cochrane Database Syst Rev. 2017  Click here
  2. New Zealand Primary Care handbook 2012, p37 Click here 
  3. Medsafe Datasheet 2014. Click here

    Gems are chosen by the Goodfellow director Dr. Bruce Arroll to be either practice changing or practice maintaining. The information is educational and not clinical advice.


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    As published in NZ Doctor 10/05/2017