Repositioning β Blockers as First-Line Therapy for Hypertension: The Lancet's Perspective

18 Oct 2023 • The Lancet's viewpoint on the recent repositioning of β blockers as a first-line therapy for hypertension is that it departs from established practice. The authors of a recently published article in the journal express apprehension that the reclassification of β blockers as a first-line therapy may have adverse consequences because of inferior stroke protection.


  • In the recent updates to their guidelines, the European Society of Hypertension has chosen to elevate β blockers to the same level as thiazide diuretics, renin-angiotensin system blockers (such as ACE inhibitors and angiotensin receptor blockers), and calcium channel blockers in the treatment of hypertension. This shift in status for β blockers is justified by their frequent use in managing various clinical conditions commonly associated with hypertension, which allows for a dual-purpose treatment approach.
  • In most current national and international hypertension guidelines, β blockers are only considered to be an alternative when there are specific indications. Compared with the other first-line antihypertensive drug classes, since β blockers are significantly less effective in preventing stroke and cardiovascular mortality.
  • However, the article emphasizes that when compared to other primary antihypertensive drug categories, β blockers are notably less effective in preventing strokes and cardiovascular mortality.
  • It is also noted that there is no new evidence supporting the shift of β blockers back to a first-line therapy.

Source: The Lancet | Read full story

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