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 .
Metoprolol Versus Thiazide Diuretics in Hypertension Morbidity Results From the MAPHY Study
The present study in hypertensive men ( 40 - 64 years old ) with untreated diastolic blood pressure above 100 mm Hg was aim ed at investigating whether metoprolol ( n = 1,609 ) given as initial treatment would lower the risk for coronary events ( sudden death and myocardial infa rct ion ) more effectively than thiazide diuretics ( n=1,625 ) . A substantial part of this study was the metoprolol arm of the Heart Attack Primary Prevention in Hypertension ( HAPPHY ) study . The HAPPHY study was a pooling of the effect of different /J-blockers , mainly metoprolol and atenolol , in which no favorable effect in relative risk was observed for atenolol as compared with diuretics . In the present study , 255 patients suffered definite coronary events during follow-up ; 25 % of these events were fatal , 39 % were acute myocardial infa rct ions , and 36 % were silent myocardial infa rct ions . The risk for coronary events was significantly lower in patients on metoprolol  than in patients on diuretics  ( 111 versus 144 cases , p=0.001 , corresponding to 143 versus 18.8 cases/1,000 patient years and a relative risk of 0.76 at the end of the trial ; 95 % confidence interval 0.58 - 0.98 ) . This difference in risk has potentially important implication s for clinical practice because of the large number of hypertensive patients who are at increased risk for coronary events . Because a placebo group , for ethical reasons , could not be included , relative risk can only be expressed in relation to diuretics . There was no difference between the two treatment groups in baseline characteristics , blood pressure during follow-up , or stroke rates . Thus , the difference in risk for coronary events is probably mediated via mechanisms other than blood pressure control . However , present data might suggest that different /3-blockers may have different efficacy in preventing coronary events . The reasons for this possibility are as yet unknown . ( Hypertension 1991:17 :
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 .