HOW WELL ARE THE CARDIOVASCULAR RISK PROFILES MODULATED BY CURRENT BETA-BLOCKERS IN HYPERTENSION

Epidemiologic studies predict that reduction of the systemic blood pre ssure by the amount usually achieved in major clinical trials could be expected to reduce cerebrovascular events by 42% and cardiac events b y 24%. Although antihypertensive treatment achieves the expected cereb rovascular benefits, the risk of coronary events is reduced by only 14 %. The reason for this dichotomy in cardiovascular protection afforded by antihypertensive drugs is unknown. Compared to treatment with othe r antihypertensive drugs, treatment with beta-adrenoceptor antagonists has not yielded a superior outcome despite the fact that they possess some cardiac pharmacodynamic properties that could be potentially adv antageous in the prevention of coronary heart disease. It is an untest ed argument that conventional beta-adrenoceptor antagonists possess un wanted metabolic effects that may counter some of their potential card iac benefits. Newer drugs of this group possess ancillary metabolic ch aracteristics which may convey more cardiac protection, but in the abs ence of results of formal clinical trials this hypothesis remains to b e tested.