Letters to the Editor
Should beta blockers remain first-line drugs for hypertension?
- Aust Prescr 2007;30:59-63
- 1 June 2007
- DOI: 10.18773/austprescr.2007.034
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Editor, – It was disappointing to read that beta blockers have fallen from favour for the treatment of hypertension (Aust Prescr 2007;30:5-7), particularly at a time when their use as prophylaxis for myocardial ischaemia in the perioperative period is being encouraged.
Myocardial ischaemia related to surgical stress often occurs in patients with no history of coronary artery disease. It is also frequently silent, but causes significant cardiac morbidity and mortality.
Beta blockers are effective prophylaxis for high risk patients1 and are recommended by the American College of Cardiology/American Heart Association guideline for perioperative cardiovascular evaluation for noncardiac surgery.2
The benefit and risk of prophylactic beta blockade in low to moderate risk patients is less clear. The POISE trial, which is currently recruiting 10 000 patients, should soon provide some definitive recommendations.3
Beta blockers may not be as effective at achieving target blood pressure as other classes of antihypertensive drugs. However, in the perioperative setting beta blockers should remain first-line therapy for blood pressure control, particularly when risk factors for ischaemic heart disease are present.
The Canberra Hospital
Dr Maros Elsik and Professor Henry Krum, authors of the article, comment:
In patients with cardiovascular comorbidities or complications as a result of hypertension, treatment needs to be individualised. In many such cases beta blockers are a reasonable option.
Their use in the perioperative setting, although not specifically discussed in our article, has been shown to improve cardiovascular outcomes mainly by reducing myocardial ischaemic events. This represents another situation where beta blockers should not necessarily be stopped or avoided.