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 .
Effect of combining extended-release carvedilol and lisinopril in hypertension: results of the COSMOS study.
Hypertension treatment commonly requires multiple agents to achieve target blood pressure ( BP ) .  β-blockers and angiotensin-converting enzyme inhibitors ( ACEIs ) are commonly co-prescribed in clinical practice although few data are available that test their additivity on BP lowering . The efficacy and safety of once-daily extended-release carvedilol ( carvedilol CR ) combined with the ACEI lisinopril in a double-blind , r and omized , factorial design study were studied . Patients ( N=656 ) with stage 1 or 2 hypertension were r and omized evenly to 1 of 15 groups for 6 weeks : carvedilol CR monotherapy 20 mg , 40 mg , or 80 mg/d ; lisinopril monotherapy 10 mg , 20 mg , or 40 mg/d ; or 1 of 9 combinations of carvedilol CR plus lisinopril initiated simultaneously . Primary efficacy measures ( assessed by ambulatory BP monitoring [ ABPM ] ) were change from baseline in 24-hour mean diastolic BP ( DBP ) and in trough ( 20 - 24 hours ) DBP . Continuous efficacy variables were assessed using analysis of covariance . Whether any combination dose was superior to its monotherapy components was assessed using the Hung AVE procedure . Despite the presence of additional BP lowering observed with most of the combinations compared with their monotherapy components , the Hung AVE test was not significant for either primary efficacy measures . Post hoc analyses of the high-dose combination groups ( carvedilol CR/lisinopril regimens of 80/10 mg , 80/20 mg , 80/40 mg , 20/40 mg , and 40/40 mg ) showed a significant treatment difference compared with both carvedilol CR 80 mg and lisinopril  40 mg for 24-hour mean DBP but not for trough DBP . With the exception of dizziness , individual adverse events did not increase with ascending doses or combinations . The superiority of initiating combination treatment with carvedilol CR and lisinopril compared with the monotherapy components was not demonstrated with the ABPM measurements . Nonetheless , the post hoc assessment combining all high-dose groups did produce significant 24-hour mean BP reduction when compared with the high-dose monotherapy groups . The tolerability profile of initiating combination therapy was generally comparable to the initiation of treatment with monotherapy
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 .