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The place of beta-blockers in the treatment of hypertension in 1993.

beta-blockers are one of the first-line therapeutic alternatives for the treatment of hypertension. Their role in this position appears stronger than earlier in view of the results of the three large intervention trials in elderly hypertensive patients (SHEP, STOP-Hypertension and MRC), which all used beta-blockers as one of their therapeutic alternatives. The secondary preventive effect of beta-blockers against coronary heart disease is well established, whereas convincing evidence from placebo-controlled trials regarding their primary preventive effect still is missing. In animal studies beta-blockers have been shown to prevent the development of coronary atherosclerosis and some of the newer agents have been shown to be markedly effective against experimentally induced myocardial ischemia. For reasons such as these, it appears safe to predict that beta-blockers will continue to play an important therapeutic role also in 1993 and beyond.