Beta blockers in hypertension to use or not to use?

Traditionally, beta blockers were used as first line agents in the treatment of uncomplicated hypertension and recommended as a class by national and international guidelines despite paucity of evidence for their cardiovascular benefit. Evidence from recent trials and metaanalyses have questioned the use of beta blocker as the preferred agent. In this article we review the data available from clinical trials to argue that beta blockers are less efficacious compared to other antihypertensive agents currently available for patients with uncomplicated hypertension. The evidence suggests that beta blockers use in patients with uncomplicated hypertension is associated with little if any cardiovascular morbidity or mortality benefit when compared to other anti-hypertensive agents or even with placebo, whether in the elderly or in the young. In contrast to newer antihypertensives such as calcium antagonists and blockers of the renin angiotensin system, beta blockers have numerous adverse effects. Based on the evidence or lack there of, we argue that beta blockers should no longer be recommended for the treatment of uncomplicated hypertension.