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 .
Limitations of Analyses Based on Achieved Blood Pressure: Lessons From the African American Study of Kidney Disease and Hypertension Trial
Blood pressure ( BP ) guidelines that set target BP levels often rely on analyses of achieved BP from hypertension treatment trials . The objective of this article was to compare the results of analyses of achieved BP to intention-to-treat analyses on renal disease progression . Participants ( n=1094 ) in the African-American Study of Kidney Disease and Hypertension Trial were r and omly assigned to  either usual BP goal defined by a mean arterial pressure goal of 102 to 107 mm Hg or lower BP goal defined by a mean arterial pressure goal of ⩽92 mm Hg . Median follow-up was 3.7 years . Primary outcomes were rate of decline in measured glomerular filtration rate and a composite of a decrease in glomerular filtration rate by > 50 % or > 25 mL/min per 1.73 m2 , requirement for dialysis , transplantation , or death . Intention-to-treat analyses showed no evidence of a BP effect on either the rate of decline in glomerular filtration rate or the clinical composite outcome . In contrast , the achieved BP analyses showed that each 10-mm Hg increment in mean follow-up achieved mean arterial pressure was associated with a 0.35 mL/min per 1.73 m2 ( 95 % CI : 0.08 to 0.62 mL/min per 1.73 m2 ; P=0.01 ) faster mean glomerular filtration rate decline and a 17 % ( 95 % CI : 5 % to 32 % ; P=0.006 ) increased risk of the clinical composite outcome . Analyses based on achieved BP lead to markedly different inferences than traditional intention-to-treat analyses , attributed in part to confounding of achieved BP with comorbidities , disease severity , and adherence . Clinicians and policy makers should exercise caution when making treatment recommendations based on analyses relating outcomes to achieved BP
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 .