What is the role, if any, for beta-blockers as initial therapy for uncomplicated hypertension?

Purpose of review: Debate continues over the role of beta-blockers in the treatment of uncomplicated hypertension. Such debate has been fuelled mainly by the emerging deleterious effects of atenolol. The purpose of this review is to summarize the latest findings on vasodilating beta-blockers in terms of central effects on blood pressure (BP) and endothelial function and evidence that these agents address fundamental physiological and prognostically relevant mechanisms for the development and progression of hypertension. Recent findings: Vasodilating beta-blockers preferentially improve central hemodynamics and reduce arterial stiffness compared with conventional beta-blockers, independent of their effects on BP reduction. Furthermore, vasodilating beta-blockers, particularly nebivolol, have positive effects on endothelial function, possibly by improving the balance between nitric oxide and peroxynitrite. Summary: The majority of evidence suggesting that beta-blockade should not be used in uncomplicated hypertension comes from studies using atenolol. It would therefore be premature and unwise to eliminate all beta-blockers from the array of agents available to optimize BP control in patients with uncomplicated hypertension by extrapolating data based almost entirely on the conventional beta-blocker atenolol. Vasodilating beta-blockers have beneficial effects on central BP, arterial stiffening, and nitric oxide-dependent endothelial dysfunction that may contribute to their clinical benefits in patients with hypertension.