BETA-BLOCKERS, DYSLIPIDEMIA, AND CORONARY-ARTERY DISEASE - A REASSESSMENT

Despite the strong association between hypertension and accelerated at herosclerosis, and the known beneficial clinical effects of beta-block ers in patients with coronary artery disease, antihypertensive trials of beta-blockers have shown only modest protection against fatal and n onfatal myocardial infarction. This review explores the explanations p ut forth for this apparent failure of beta-blockers. It also examines the clinical relevance of the metabolic effects of beta-blockers withi n the framework of the heterogeneity of this class of drugs. Recent ev idence indicates that long-term treatment of hypertension with beta-bl ockers 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 beta-blocker therapy. The metabolic in fluence of these drugs varies considerably within the class and may be of little clinical relevance. Unless it is contraindicated, an approp riate beta-blocker should be considered for the treatment of hypertens ion in patients who have coronary artery disease or who are at high ri sk for coronary artery disease.