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 .
Decreased Coronary Heart Disease in Hypertensive Smokers Mortality Results From the MAPHY Study
The present primary prevention study aim ed at investigating whether metoprolol given as initial antihypertensive treatment would lower cardiovascular complications of high blood pressure to a greater extent than thiazide diuretics .  Patients were r and omized to metoprolol ( n = 1,609 , 8,110 patient-years ) or a thiazide diuretic ( n = 1,625 , 8,070 patient-years ) . At r and omization , 535 patients in the metoprolol group and 524 patients in the diuretic group were classified as smokers . Blood pressure control during follow-up was equally effective regardless of smoking habits at r and omization . Cardiovascular and coronary heart disease mortality was three to four times higher in smokers than in nonsmokers , underlining the importance of smoking as a risk factor . Total and cardiovascular mortality were significantly lower for the metoprolol group than for the thiazide diuretic group in the whole study population ( p = 0.028 and p = 0.012 ) , as well as in smokers ( p = 0.013 and p = 0.016 ) . Coronary heart disease mortality was significantly lower for patients on metoprolol  than for patients on diuretics  in the whole study population ( p = 0.048 ) as well as in smokers ( p = 0.02l ) . The results suggest that initial antihypertensive therapy with metoprolol is associated with a lesser incidence of total , cardiovascular , and coronary heart disease mortality as compared with initial diuretic treatment , both in the whole study population and in smokers . The favorable effect of metoprolol must be mediated via mechanisms other than the blood pressure-lowering effect of metoprolol because equal blood pressure control was achieved with both types of medication , irrespective of smoking habits at r and omization
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 .