When the blood pressure lowering effect of beta-blockers from this review was compared to that of thiazide diuretics from our previous review ( Chen 2009 ) , second-line beta-blockers reduce systolic BP to the same extent as second-line thiazide diuretics , but reduce diastolic BP to a greater degree .
The different effect on diastolic BP means that beta-blockers have little or no effect on pulse pressure whereas thiazides cause a significant dose-related decrease in pulse pressure .
This difference in the pattern of BP lowering with beta-blockers as compared to thiazides might be the explanation for the fact that beta-blockers appear to be less effective at reducing adverse cardiovascular outcomes than thiazide diuretics , particularly in older individuals
BACKGROUND Beta-blockers are one of the more commonly prescribed classes of anti-hypertensive drugs , both as first-line and second-line .
OBJECTIVES To quantify the effect on systolic blood pressure ( SBP ) , diastolic blood pressure ( DBP ) , heart rate and withdrawals due to adverse effects of beta-blocker therapy when given as a second-line drug in adult patients with primary hypertension .
Combination of verapamil and beta blockers in systemic hypertension.
The efficacy and safety of verapamil and propranolol were examined in 14 hypertensive patients ( mean age 51.2 , range 30 to 65 ) in a double-blind , r and omized , crossover study of verapamil , 360 mg , propranolol , 240 mg , these 2 formulations in combination and placebo , each given for 4 weeks . Supine blood pressure , heart rate , atrioventricular conduction ( PR interval ) and left ventricular function were measured . All treatments reduced diastolic blood pressure ( mean + /- st and ard deviation ) ( p less than 0.001 ) : placebo to 106.6 + /- 8.1 mm Hg ; propranolol to 93.8 + /- 7.7 ; verapamil to 89.8 + /- 7.8 ; the combination to 84.1 + /- 6.1 , but the effect of the combination was significantly greater than that of either drug alone ( p less than 0.05 ) . Heart rate at rest ( placebo , 80.2 + /- 12.2 beats/min ) was reduced by propranolol ( 63.3 + /- 9.4 , p less than 0.001 ) , but not by verapamil ( 79.0 + /- 8.9 ) . However , the addition of verapamil to propranolol led to a further reduction in heart rate ( 56.9 + /- 8.4 , p less than 0.005 ) . PR interval was prolonged significantly by the combination ( 185.5 + /- 35.3 ms ) when compared with placebo ( 154.0 + /- 22.7 ) ; propranolol ( 159.1 + /- 21.2 ) and verapamil ( 165.5 + /- 32.4 ) ( p less than 0.005 for each ) . The active drugs increased end-diastolic dimension and end-systolic dimension . For each variable , the effect of the combination was statistically significant ( p less than 0.01 ) . Fractional shortening was not altered significantly by any of the treatments . Thus verapamil plus propranolol is a very effective antihypertensive combination but heart rate , atrioventricular conduction and left ventricular function may be affected adversely , necessitating careful monitoring of therapy
When the blood pressure lowering effect of beta-blockers from this review was compared to that of thiazide diuretics from our previous review ( Chen 2009 ) , second-line beta-blockers reduce systolic BP to the same extent as second-line thiazide diuretics , but reduce diastolic BP to a greater degree .
The different effect on diastolic BP means that beta-blockers have little or no effect on pulse pressure whereas thiazides cause a significant dose-related decrease in pulse pressure .
This difference in the pattern of BP lowering with beta-blockers as compared to thiazides might be the explanation for the fact that beta-blockers appear to be less effective at reducing adverse cardiovascular outcomes than thiazide diuretics , particularly in older individuals
BACKGROUND Beta-blockers are one of the more commonly prescribed classes of anti-hypertensive drugs , both as first-line and second-line .
OBJECTIVES To quantify the effect on systolic blood pressure ( SBP ) , diastolic blood pressure ( DBP ) , heart rate and withdrawals due to adverse effects of beta-blocker therapy when given as a second-line drug in adult patients with primary hypertension .