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Messerli FH  
Antihypertensive Therapy: Beta-Blockers and Diuretics - What is the Evidence?

Journal of Clinical and Basic Cardiology 2001; 4 (3): 201-204

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Keywords: BetablockerDiuretikumHypertonieHämodynamikKardiologiebeta-blockercardiologydiureticshaemodynamichypertension

Both diuretics and beta-blockers have been used to treat essential hypertension for more than three decades. Both of these drug classes have an impressive track record with regard to safety that is unparalleled for other drugs. Despite this, no prospective randomised study has shown that beta-blockers, either in monotherapy or when added to diuretic therapy, independently diminish cardiovascular morbidity and mortality. Quite to the contrary, our recent meta-analysis in the elderly reported little, if any, benefits of beta-blocker therapy when compared with placebo or other therapy, despite the fact that blood pressure was lowered by beta-blockers. The reason for the inefficacy of beta-blockers may come from their unfavorable effects on systemic haemodynamics and on other pathophysiologic findings in the hypertensive patient, such as arterial stiffness, hypertensive heart disease, kidney disease and cerebrovascular disease. In addition, comorbid conditions often present in the elderly, such as chronic obstructive pulmonary disease, peripheral vascular disease, diabetes, depression, and erectile dysfunction, are relative contraindications to the use of beta-blockers.
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