How well are the cardiovascular risk profiles modulated by current beta blockers in hypertension?

Epidemiologic studies predict that reduction of the systemic blood pressure by the amount usually achieved in major clinical trials could be expected to reduce cerebrovascular events by 42% and cardiac events by 24%. Although antihypertensive treatment achieves the expected cerebrovascular benefits, the risk of coronary events is reduced by only 14%. The reason for this dichotomy in cardiovascular protection afforded by antihypertensive drugs is unknown. Compared to treatment with other antihypertensive drugs, treatment with beta-adrenoceptor antagonists has not yielded a superior outcome despite the fact that they possess some cardiac pharmacodynamic properties that could be potentially advantageous in the prevention of coronary heart disease. It is an untested argument that conventional beta-adrenoceptor antagonists possess unwanted metabolic effects that may counter some of their potential cardiac benefits. Newer drugs of this group possess ancillary metabolic characteristics which may convey more cardiac protection, but in the absence of results of formal clinical trials this hypothesis remains to be tested.