Why ß-blockers are not cardioprotective in elderly patients with hypertension

Despite the fact that ß-blockers have been used for the treatment of hypertension for more than 30 years, no study has shown that their use reduces morbidity and mortality in the elderly. To the contrary, the British Medical Research Council trial in the elderly documented that although blood pressure was lowered effectively and significantly by atenolol, morbidity and mortality in the ß-blocker group did not differ from that of the placebo group. Not only was ß-blocker monotherapy not effective, but patients who received the combination of ß-blockers and diuretics fared consistently worse than those on diuretics alone. ß-blockers are less effective than diuretics in lowering blood pressure, and are poorly tolerated in the elderly. The reason for their inefficacy in the elderly may be related to their inherent unfavorable effect on systemic hemodynamics and pathophysiologic findings in the arterial tree, heart, kidneys, brain, and on the metabolism of lipids and carbohydrates. Decreased ß-adrenergic responsiveness with age and comorbid conditions makes ß-blockers unattractive. Thus, they should not be considered appropriate for first-line therapy of uncomplicated hypertension in the geriatric population.