Drug treatment - Antihypertensive drugs - The present role of beta blockers and alpha blockers

There are several lines of evidence implicating increased sympathetic activ ity not only in the maintenance of raised blood pressure but in the pathoph ysiology of hypertensive complications including atherosclerosis. Beta bloc kers are one of the best documented classes of drugs in terms of long term safety and improvement in outcome in hypertension. They are also well estab lished to reduce reinfarction in patients after myocardial infarction and t o improve survival in patients with congestive heart failure. Side effects of beta blockers are predictable and result from excess pharmacological act ivity. They can often be controlled by dose adjustments. Alpha blockers reduce peripheral resistance. They are as effective as other classes at lowering blood pressure although to date there is little or no long term outcome data with this class. Reduction of sympathetic activity with beta and/or alpha blockers should re main amongst the first choices for monotherapy (or add-on therapy) in essen tial hypertension.