The role of β-blockers in the management of hypertension: An Asian perspective

Abstract

Following publication of the National Institute of Clinical Excellence (NICE) Guidelines in 2006, the use of β-blockers as first-line therapy in hypertension has been somewhat controversial. However, a recent reappraisal of the European Society of Hypertension guidelines highlights that these agents exhibit similar BP lowering efficacy to other classes of agents, prompting a re-examination of the utility of these agents in various patient populations. The authors felt that it is important to address this controversy and provide an Asian perspective on the place of β-blockers in current clinical practice and the benefits of β-blockade in selected patient populations. In addition to their use as a potential first-line therapy in uncomplicated hypertension, β-blockers have a particular role in patients with hypertension and comorbidities such as heart failure or coronary artery disease, including those who had a myocardial infarction. One advantage which β-blockers offer is the additional protective effects in patients with prior cardiovascular events. Some of the disadvantages attributed to β-blockers appear more related to the older drugs in this class and further appraisal of the efficacy and safety profile of newer β-blockers will lend support to the current guideline recommendations in Asian countries and encourage increased appropriate use of β-blockade in current clinical practice within Asia.

Key words::

• Adrenergic β-antagonists
• Asia
• Guidelines
• Hypertension

Transparency

Funding

Supported by an educational grant from Merck Serono

Declaration of financial/other relationships

B.T. received sponsorship from Abbott Laboratories Ltd, AstraZeneca and Merch Serono. He also received grant/research funding from Abbott Laboratories Ltd, AstraZeneca, Daiichi Sankyo, GlaxoSmithKline, Johnson & Johnson, Merck Serono, Merck Sharp and Dohme, and Roche. He is an advisor to AstraZeneca, Merck Serono, and Merck Sharp and Dohme. He is in the speaker bureau for Abbott Laboratories Ltd, AstraZeneca, Merck Serono, Merck Sharp and Dohme, and Servier. CMRO peer reviewers may have received honoraria for their review work. The peer reviewers on this manuscript have disclosed that they have no relevant financial relationships.

J.J.D. is an advisory board member to Merck Serono. He is also consultant to Novartis and Eris Life Sciences Pvt Ltd, and an instructor for India Medtronic Pvt Ltd.

J.H. is an advisory board member to Merck Serono.

L.P.L. received sponsorship from AstraZeneca and Novartis, and research grant from Servier. He is an advisor to Merck Serono, Merck Sharp and Dohme, AstraZeneca, Eli Lilly, Novo Nordisk, and Novartis. He is in the speaker bureau for AstraZeneca, Merck Sharp and Dohme, and Novartis. He also received honoraria from AstraZeneca, Novartis and PACE.

C.G.P. is an advisory board member to Merck Serono.

A.R.A.R. is an advisor to Merck Serono, Eastern Medical and AstraZeneca. He is in the speaker bureau for Servier, Merck Sharp and Dohme, AstraZeneca, Eastern Medical, Novartis and Merck Serono.

E.B.R. is an advisory board member to Merck Serono.

A.A.S. is an advisory board member to Merck Serono.

A.H. is an advisor to Merck Serono and is in the speaker bureau for Boryung Pharma.

F.F. served as a speaker for Merck Serono.

Acknowledgments

No assistance in the preparation of this article is to be declared