Are ß-blockers outdated as antihypertensive monotherapy?
Hypertension guidelines of national and international societies for decades recommended ß-adrenoceptor antagonists (ß-blockers) as first-line antihypertensive medication. This recommendation may change; in fact, in the very recently revised British hypertension guidelines, ß-blockers are not a first choice in the drug therapy of essential hypertension. Which study triggered this revolution? After all, there is no new data apart from Lindholm et al. [1], who performed a meta-analysis of all randomized controlled trials in essential hypertension involving ß-blockers as first-line agent compared with either active (13 trials, 105 951 participants) or placebo control (seven trials, 27 433 participants) and all-cause or cardiovascular mortality, myocardial infarction and stroke as outcomes. Compared with placebo, ß-blockers reduced stroke by 19% (relative risk reduction) which was only half of the expected effect based on blood pressure lowering; myocardial infarction and total mortality we
