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Management of hypertension. What is the role of beta blockers?

The 1984 report of the Joint National Committee on Detection, Evaluation, and Treatment of Hypertension for the first time recommended beta blockers as an alternative to diuretics for step 1 of stepped-care treatment. Numerous studies have shown that beta blockers are as effective as diuretics for monotherapy in patients with mild hypertension. They are the only antihypertensive drugs that have been shown to be cardioprotective following a myocardial infarction. Beta blockers are especially indicated for step 1 therapy in young patients (particularly those with evidence of hyperkinetic circulation), in patients who have had a myocardial infarction, and in patients with angina, migraine, or hereditary tremor because they are helpful in treating these conditions as well as in managing hypertension. Angiotensin converting enzyme inhibitors and calcium channel blockers are challenging beta blockers and diuretics as the drugs of choice for initial therapy of hypertension in selected patients. Time will ultimately determine the relative roles of each as step 1 therapy.