β-blockers are not all the same: pharmacologic similarities and differences, potential combinations and clinical implications
Stefano Taddei, Nqoba Tsabedze, Ru‐San Tan
Abstract
b-blockers are a heterogeneous class, with individual agents distinguished by selectivity for b 1 -vs.b 2and a-adrenoceptors, presence or absence of partial agonist activity at one of more b-receptor subtype, presence or absence of additional vasodilatory properties, and lipophilicity, which determines the ease of entry the drug into the central nervous system.Cardioselectivity (b 1 -adrenoceptor selectivity) helps to reduce the potential for adverse effects mediated by blockade of b 2 -adrenoceptors outside the myocardium, such as cold extremities, erectile dysfunction, or exacerbation of asthma or chronic obstructive pulmonary disease.According to recently updated guidelines from the European Society of Hypertension, b-blockers are included within the five major drug classes recommended as the basis of antihypertensive treatment strategies.Adding a b-blocker to another agent with a complementary mechanism may provide a rational antihypertensive combination that minimizes the adverse impact of induced sympathetic overactivity for optimal blood pressure-lowering efficacy and clinical outcomes benefit.