Atenolol  was the beta‐blocker most used .
Current evidence suggests that initiating treatment of hypertension with beta‐blockers leads to modest CVD reductions and little or no effects on mortality .
These beta‐blocker effects are inferior to those of other antihypertensive drugs .
Abstract Background Beta‐blockers refer to a mixed group of drugs with diverse pharmacodynamic and pharmacokinetic properties .
They have shown long‐term beneficial effects on mortality and cardiovascular disease ( CVD ) when used in people with heart failure or acute myocardial infa rct ion .
Beta‐blockers were thought to have similar beneficial effects when used as first‐line therapy for hypertension .
However , the benefit of beta‐blockers as first‐line therapy for hypertension without compelling indications is controversial .
This review is an up date of a Cochrane Review initially published in 2007 and up date d in 2012 .
Objectives To assess the effects of beta‐blockers on morbidity and mortality endpoints in adults with hypertension .
Comparison of carvedilol and metoprolol on clinical outcomes in patients with chronic heart failure in the Carvedilol Or Metoprolol European Trial (COMET): randomised controlled trial
BACKGROUND Beta blockers reduce mortality in patients who have chronic heart failure , systolic dysfunction , and are on background treatment with diuretics and angiotensin-converting enzyme inhibitors .  We aim ed to compare the effects of carvedilol and metoprolol on clinical outcome . METHODS In a multicentre , double-blind , and r and omised parallel group trial , we assigned 1511 patients with chronic heart failure to treatment with carvedilol ( target dose 25 mg twice daily ) and 1518 to metoprolol ( metoprolol tartrate , target dose 50 mg twice daily ) . Patients were required to have chronic heart failure ( NYHA II-IV ) , previous admission for a cardiovascular reason , an ejection fraction of less than 0.35 , and to have been treated optimally with diuretics and angiotensin-converting enzyme inhibitors unless not tolerated . The primary endpoints were all-cause mortality and the composite endpoint of all-cause mortality or all-cause admission . Analysis was done by intention to treat . FINDINGS The mean study duration was 58 months ( SD 6 ) . The mean ejection fraction was 0.26 ( 0.07 ) and the mean age 62 years ( 11 ) . The all-cause mortality was 34 % ( 512 of 1511 ) for carvedilol and 40 % ( 600 of 1518 ) for metoprolol ( hazard ratio 0.83 [ 95 % CI 0.74 - 0.93 ] , p=0.0017 ) . The reduction of all-cause mortality was consistent across predefined subgroups . The composite endpoint of mortality or all-cause admission occurred in 1116 ( 74 % ) of 1511 on carvedilol and in 1160 ( 76 % ) of 1518 on metoprolol ( 0.94 [ 0.86 - 1.02 ] , p=0.122 ) . Incidence of side-effects and drug withdrawals did not differ by much between the two study groups . INTERPRETATION Our results suggest that carvedilol extends survival compared with metoprolol
Atenolol  was the beta‐blocker most used .
Current evidence suggests that initiating treatment of hypertension with beta‐blockers leads to modest CVD reductions and little or no effects on mortality .
These beta‐blocker effects are inferior to those of other antihypertensive drugs .
Abstract Background Beta‐blockers refer to a mixed group of drugs with diverse pharmacodynamic and pharmacokinetic properties .
They have shown long‐term beneficial effects on mortality and cardiovascular disease ( CVD ) when used in people with heart failure or acute myocardial infa rct ion .
Beta‐blockers were thought to have similar beneficial effects when used as first‐line therapy for hypertension .
However , the benefit of beta‐blockers as first‐line therapy for hypertension without compelling indications is controversial .
This review is an up date of a Cochrane Review initially published in 2007 and up date d in 2012 .
Objectives To assess the effects of beta‐blockers on morbidity and mortality endpoints in adults with hypertension .