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September 27, 1993

ß-Blockers, Dyslipidemia, and Coronary Artery Disease: A Reassessment

Author Affiliations

From the Georgetown University Medical Center, Washington, DC.

Arch Intern Med. 1993;153(18):2085-2092. doi:10.1001/archinte.1993.00410180027003

Despite the strong association between hypertension and accelerated atherosclerosis, and the known beneficial clinical effects of β-blockers in patients with coronary artery disease, antihypertensive trials of β-blockers have shown only modest protection against fatal and nonfatal myocardial infarction. This review explores the explanations put forth for this apparent failure of β-blockers. It also examines the clinical relevance of the metabolic effects of β-blockers within the framework of the heterogeneity of this class of drugs. Recent evidence indicates that long-term treatment of hypertension with β-blockers that do not possess intrinsic sympathomimetic activity reduces the occurrence of cardiac complications of hypertension. There are no data to show a quantified effect on clinical outcome of the lipid and glucose changes associated with β-blocker therapy. The metabolic influence of these drugs varies considerably within the class and may be of little clinical relevance. Unless it is contraindicated, an appropriate β-blocker should be considered for the treatment of hypertension in patients who have coronary artery disease or who are at high risk for coronary artery disease.

(Arch Intern Med. 1993;153:2085-2092)