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Author: Admin | 2025-04-28
Especially obviously does not hold true for atenolol since it has been shown in a large meta-analysis2 that this drug caused significantly higher mortality than other active treatments whereas non-atenolol beta-blockers showed a (non-significant) tendency to decrease both mortality and myocardial infarction compared to other antihypertensives.2 Therefore, the authors concluded: “Our results cast doubts on atenolol as a suitable drug for hypertensive patients. Moreover, they challenge the use of atenolol as a reference drug in outcome trials in hypertension.” Unfortunately, most outcome studies in arterial hypertension showing other antihypertensives being “better” than beta-blockers used atenolol as a reference drug. Neverheless,other beta-blockers of the 2nd generation, especiallly metoprolol and bisoprolol, still remain indicated particularly in the treatment of coronary artery disease, tachyarrhythmias and heart failure since they never were shown to share these disadvantages with atenolol.Due to their additional vasodilating effects Beta-blockers of the 3rd generation are particularly useful in patients with arterial hypertension and/or heart failure. However, beta-blockers have been questioned in the treatment of arterial hypertension since they may cause metabolic side effects, whereas this obviously does not hold true for the 3rd generation. Accordingly, the 2007 Guidelines for the management of arterial hypertension of the European Society of Hypertension and the European Society of, Cardiology4,5 emphasise that “this may not apply, however, to vasodilator beta-blockers, such as carvedilol and nebivolol, which have less or no metabolic action, as well as a reduced incidence of new onset diabetes compared with classical beta-blockers.” Indeed, it has been shown that nebivolol rather decreases than increases the incidence of new onset diabetes compared to placebo6 and carvedilol shows rather favourable metabolic effects such as an increase of the insulin sensitivity index and a decrease in triglyceride plasma concentrations7. Therefore, in this context3) 3rd generation beta-blockerscarvedilol and nebivolol clearly differ from the those of the 1st and 2nd generation since theydo not show unfavourable metabolic side effects.II – 4 “special beta-blockers”Finally, please find a short overview of four “special beta-blockers” featuring particular additional effects (table 2):1) Nebivololis one of the “youngest members” of the family of beta-blockers widely used in clinical practice. Actually,
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