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Comment & Response
February 26, 2014

β-Blocker Therapy for Patients With Hypertension—Reply

Author Affiliations
  • 1Hatter Institute for Cardiovascular Research in Africa, University of Cape Town Medical School, Cape Town, South Africa
  • 2Centre for Evidence-Based Health Care, Stellenbosch University, Cape Town, South Africa
JAMA. 2014;311(8):862-863. doi:10.1001/jama.2014.336

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.