Vnitr Lek 1996, 42(6):420-425

[Do beta-blockers have a role in the modern treatment of arterial hypertension?].

K Horký: II. interní klinika 1. LF UK a VFN, Praha.

The submitted review draws attention to advantages and pitfalls of the use of betablockers in the treatment of arterial hypertension. Despite certain metabolically adverse effects which are reduced to a minimum in small doses and more recent betablockers, the latter are along with diuretics the only antihypertensive agents where unequivocally the the long-term favourable effect on the general and cardiovascular mortality was proved. In other hypertensive agents results are expected after completion of multicentric studies which are underway. Beta-blockers, as monotherapy or combined with other drugs, are the drug of choice in the treatment of essential hypertension in young hypertonic patients with hyperkinetic circulation, a tendency for tachycardia, in hypertonic patients with ischaemic heart disease after myocardial infarction or with angina pectoris. In these subjects they quite obviously reduce the general as well as cardiovascular mortality, sudden death and myocardial re-infarction. Betablockers are effective also in elderly hypertonic patients where preparations with ISA or beta 1-selective preparations are more useful. With a certain amount of care similar types of beta-blockers or beta-blockers with a dual effect can be used in hypertension associated with diabetes mellitus, hyperlipoproteinaemia or ischaemia of the lower extremities. Beta-blockers are irreplaceable among antihypertensives of first choice and are experiencing their revival being effective, safe, cheap and well tolerated antihypertensive drugs. Their other properties such as the degree of selectivity, the presence of internal sympathetic activity, combined dual effect, lipophilic or hydrophilic character, enable us to indicate different preparations "tailored" with regard to the severity of hypertension, organ complications and associated diseases.