SELECTIVE VERSUS NONSELECTIVE BETA-ADRENOCEPTOR ANTAGONISTS IN HYPERTENSION

The application of cost-effectiveness methodology is particularly impo rtant in widespread diseases such as hypertension. However, because pr ospective cost-effectiveness analyses comparing different antihyperten sive drugs are not currently available, differences in the cost effect iveness of these drugs can only be estimated. The purpose of this revi ew is to estimate and compare the costs of drug therapy with selective and nonselective beta adrenoceptor antagonists in hypertension. The g lobal costs of antihypertensive treatment are largely determined by dr ug costs. In most countries, drug costs do not appear to vary substant ially between beta(1)-selective and nonselective beta-blockers. The ad verse sequelae of hypertension include stroke, myocardial infarction, cardiac hypertrophy and renal failure. There are no obvious difference s in effect on stroke and cardiac hypertrophy between beta(1)-selectiv e and nonselective beta-blockers. However, compared with beta(1)-selec tive antagonists, nonselective drugs might be less effective in preven ting myocardial infarction in smokers and may impair renal function in patients with both increased peripheral resistance and declining card iac output. There is a clear difference between beta(1)-selective and nonselective beta-blockers on quality-of-life (QOL) perception. During treatment with nonselective beta-blockers, QOL perception is lower th an during treatment with beta(1)-selective drugs. Preservation of qual ity of life during long term antihypertensive treatment deserves consi derable weight in economic analyses. Consequently, the more favourable effects of beta(1)-selective agents on quality of life may outweigh t he possible higher costs of these drugs, and suggest that beta(1)-sele ctive agents may be more cost effective than nonselective beta-blocker s.