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 .
Tolerability of &bgr;-Blocker Initiation and Titration in the Metoprolol CR/XL Randomized Intervention Trial in Congestive Heart Failure (MERIT-HF)
Background —&bgr;-Blockade improves survival when administered over a long period of time to patients with heart failure . However , the time course of any possible deterioration during the titration phase has not been reported . Methods and Results —We looked at evidence of clinical deterioration in the Metoprolol CR/XL R and omized Intervention Trial in Congestive Heart Failure ( MERIT-HF ) by analyzing events and symptoms during the first 90 days . During titration , the Kaplan-Meier curves for the combined end point of all-cause mortality/all-cause hospitalization were similar in all patients r and omized , with no significant difference in favor of placebo at any visit or in any of the analyzed subgroups ( New York Heart Association class II , III/IV , or III/IV with ejection fraction < 0.25 , heart rate ≤76 bpm , and systolic blood pressure ≤120 mm Hg ) . The curves started to diverge in favor of & bgr;-blockade after 60 days . Low heart rate was the main factor that limited titration . In New York Heart Association class III/IV , 5.9 % of the patients receiving placebo discontinued study medicine during the first 90 days compared with 8.1 % of those receiving metoprolol CR/XL ( P = 0.037 unadjusted , P = NS adjusted ) ; corresponding figures in those with New York Heart Association class III/IV and ejection fraction < 0.25 were 7.1 % and 8.0 % ( P = NS ) . From day 90 until the end of the study , more patients in the placebo group discontinued study medicine in all subgroups . There was no change in diuretic or ACE inhibitor dosing with & bgr;-blocker titration . Most patients reported no change in symptoms of breathlessness or fatigue during the titration phase . Conclusions —When carefully titrated , metoprolol CR/XL can be given safely to the overwhelming majority of patients with stable mild to moderate heart failure  , with minimal side effects or deterioration
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 .