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 .
The Cardiac Insufficiency Bisoprolol Study II (CIBIS-II): a randomised trial
BACKGROUND In patients with heart failure , beta-blockade has improved morbidity and left-ventricular function , but the impact on survival is uncertain . We investigated the efficacy of bisoprolol , a beta1 selective adrenoceptor blocker in decreasing all-cause mortality in chronic heart failure . METHODS In a multicentre double-blind r and omised placebo-controlled trial in Europe , we enrolled 2647 symptomatic patients in New York Heart Association class III or IV , with left-ventricular ejection fraction of 35 % or less receiving st and ard therapy with diuretics and inhibitors of angiotensin-converting enzyme .  We r and omly assigned patients bisoprolol 1.25 mg ( n=1327 ) or placebo ( n=1320 ) daily , the drug being progressively increased to a maximum of 10 mg per day . Patients were followed up for a mean of 1.3 years . Analysis was by intention to treat . FINDINGS CIBIS-II was stopped early , after the second interim analysis , because bisoprolol showed a significant mortality benefit . All-cause mortality was significantly lower with bisoprolol than on placebo ( 156 [ 11.8 % ] vs 228 [ 17.3 % ] deaths with a hazard ratio of 0.66 ( 95 % CI 0.54 - 0.81 , p<0.0001 ) . There were significantly fewer sudden deaths among patients on bisoprolol than in those on placebo ( 48 [ 3.6 % ] vs 83 [ 6.3 % ] deaths ) , with a hazard ratio of 0.56 ( 0.39 - 0.80 , p=0.0011 ) . Treatment effects were independent of the severity or cause of heart failure . INTERPRETATION Beta-blocker therapy had benefits for survival in stable heart-failure patients . Results should not , however , be extrapolated to patients with severe class IV symptoms and recent instability because safety and efficacy has not been established in these patients
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 .