In Reply Dr Cruikshank stresses the role of sympathetic activity, which transmits both α- and β-mediated stimuli, in the optimal control of blood pressure; however, he mainly focuses on studies of β-blockers, thereby ignoring the important role of countering both divisions of the autonomic nervous system. That overall sympathetic activity is involved in severe hypertension has been known since the time of Smithwick1 who showed the efficacy of total sympathectomy in 1949. Recent studies of renal artery denervation for severe hypertension also show that the ideal for sympathetic blockade is total (ie, α and β) and not specifically β. Yet large-scale outcome studies with α- and β-blockers are still lacking.
Opie LH, Wiysonge CS. β-Blocker Therapy for Patients With Hypertension—Reply. JAMA. 2014;311(8):862-863. doi:10.1001/jama.2014.336