Sequential drug decision problems in long-term medical conditions: a case Study of Primary Hypertension Eunju Kim ba, ma, msc

(2) Beta-blockers (or beta-adrenergic blocking agents)

Beta-blockers (BBs) directly work on the cardiovascular system. They reduce the heart rate, cardiac contractility and output; renin release from the kidney and central release of adrenergic substances; and inhibit norepinephrine release peripherally. All these contribute to their antihypertensive effects. They are especially useful in patients with angina pectoris, previous MI, stable angina pectoris, migraine headaches and somatic manifestations of anxiety.

BBs are used cautiously in patients with type 1 DM, since they can mask the symptoms of hypoglycemia and prolong these episodes by inhibiting gluconeofenesis. They are also associated with rest pain or non-healing ulcers in patients with advanced peripheral vascular disease. The AEs include exacerbating bronchospasm in those with asthma and some patients with chronic obstructive pulmonary disease (COPD); sinus node dysfunction and atrioventricular conduction depression; precipitating or worsening clinically important left ventricular failure; nasal congestion; Raynaud’s phenomenon; and central depression and confusion. Adverse biochemical effects include altered lipids and increased glucose concentrations.

Because of the lack of efficacy in prevention of MI and inferiority compared with other drugs in prevention of stroke and left ventricular hypertrophy, there is now increasing doubt whether BBs should still be regarded as ideal first-line drugs in the treatment of hypertension without specific compelling indications^{[230, 231]}.