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 .
Effects of the direct renin inhibitor aliskiren and atenolol alone or in combination in patients with hypertension1
Introduction . Aliskiren is the first in a new class of direct renin inhibitors to be approved for the treatment of hypertension . Patients and methods . In this double-blind , multicentre trial , 694 patients with hypertension ( mean sitting diastolic blood pressure [ BP ] ≥ 95 and < 110 mmHg ) were r and omised to once-daily aliskiren 150 mg ( n=231 ) , atenolol 50 mg ( n=231 ) or the combination ( 150/50 mg ; n=232 ) for six weeks , followed by a further six weeks on double the initial doses of aliskiren and atenolol . Efficacy ( reduction from baseline in mean sitting systolic and diastolic BP ) and tolerability of study treatments were assessed ; plasma renin activity ( PRA ) was measured in a subset of patients . Results . At Week 12 endpoint , aliskiren , atenolol and aliskiren/atenolol  lowered systolic and diastolic BP from baseline by 14.3/11.3 , 14.3/13.7 and 17.3/14.1 mmHg , respectively . Systolic BP reductions with aliskiren/atenolol were significantly greater than those with aliskiren ( p=0.039 ) or atenolol ( p=0.034 ) alone , and diastolic BP reductions were greater than with aliskiren alone ( p<0.001 ) . Diastolic BP changes were larger with atenolol than with aliskiren ( p=0.003 , correlating with the large reductions in pulse rate ( > 10 bpm ) observed with atenolol . Aliskiren , atenolol and aliskiren/atenolol  reduced geometric mean PRA from baseline by 65 % , 52 % and 61 % , respectively . In patients with moderate or high baseline PRA ( ≥ 0.65 ng/ml/hour ) , PRA was reduced to low levels ( < 0.65 ng/ml/hour ) at Week 12 endpoint in a greater proportion of patients receiving aliskiren ( 11/15 patients , 73.3 % ) or aliskiren/atenolol ( 18/23 , 78.3 % ) than with atenolol ( 10/21 , 47.6 % ) . Aliskiren treatment was associated with numerically lower rates of adverse events and discontinuations due to adverse events  compared with atenolol or combination treatment , and unlike atenolol was not associated with bradycardia . Conclusions . Direct renin inhibition with aliskiren may be an appropriate substitute for beta-blocker treatment in patients with uncomplicated hypertension .  Aliskiren also represents an attractive option for dual therapy with atenolol to improve systolic BP/pulse pressure reductions and BP control with maintained tolerability compared with atenolol alone
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 .