ANTIATHEROGENIC EFFECTS OF BETA-ADRENERGIC BLOCKING-AGENTS - THEORETICAL, EXPERIMENTAL, AND EPIDEMIOLOGIC CONSIDERATIONS

Theoretical considerations and results from experimental studies in an imal models suggest that long-term beta-adrenergic blockade should be antiatherogenic. Some of these experimental results indicate that beta -blockers could inhibit atherogenesis and thus prevent clinical events independently of any effects on blood pressure through concomitant re ductions in heart rate, blood velocity and energy, endothelial permeab ility to lipoproteins, and the likelihood of plaque rupture. Any such independent inhibition of atherogenesis implies, in turn, that beta-bl ockers might be more desirable than alternative antihypertensive thera pies in persons at high risk for atherosclerotic diseases. Results of the three major trials directly comparing beta-blockers to diuretics i n the primary prevention of coronary heart disease among patients with hypertension were largely inconclusive. However, ancillary data from these and other trials are consistent in demonstrating that beta-adren ergic blockade is associated with anti-coronary heart disease effects and, thus, is perhaps antiatherogenic. A definitive evaluation of the antiatherogenic effects of beta-blockers is not forthcoming because no large clinical trials directly assessing the effect of these drugs on atherosclerosis have been done or are planned.