Treatment of high blood pressure remains a cornerstone in stroke prevention, and beta‐blockers have now been used to treat hypertension and prevent strokes for almost 5 decades. The first beta‐blocker to be used in clinical medicine, propranolol, was originally invented to provide relief for patients with angina pectoris. It was specifically designed to block the beta adrenergic receptors of the heart, thus decreasing the myocardial oxygen demand. It was soon found, however, that the newly developed drug could also be used as a blood pressure lowering medication. Placebo‐controlled trials such as the landmark MRC trial demonstrated a reduced risk for stroke in hypertensive patients who used beta‐blockers. Indeed, the clinical usefulness of beta‐blockers led to its inventor, Sir James Black, being awarded with the Nobel Prize in Physiology or Medicine in 1988. However, modern hypertension trials have suggested that at similar attained blood pressure levels, beta‐blockers are actually less effective than angiotensin receptor blockers or calcium channel blockers, in terms of stroke prevention. The same picture has emerged from the most recent meta‐analysis on this topic, in which beta‐blocker use was associated with decreased risk for stroke compared with placebo, but beta‐blocker use was also associated with increased risk
Journal of Clinical Hypertension – Wiley
Published: Jan 1, 2018
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