You may have read the news reports voicing doubt about whether beta-blockers should be used to treat high blood pressure. A team of physicians from the United Kingdom has issued new guidelines which omit beta-blockers for routine use in the treatment of hypertension.

Their recommendations are based on analysis of trials that directly compared beta-blockers with other antihypertensive drugs and showed that beta-blockers were less effective than the other drugs in preventing cardiovascular events, especially strokes.

One problem I see with this analysis is that just one beta-blocker, atenolol, was used in most of these comparative trials, so it's not known whether the other beta-blockers would have done a better job of preventing strokes. (Atenolol is the most commonly used beta-blocker and the fourth most frequently prescribed medication in the U.S.)

The British guidelines indicate that beta-blockers should still be used in patients with angina, heart failure, or a history of a heart attack, whether or not they also have high blood pressure.

These new guidelines were supported by some, but not all, American hypertension experts. The American experts agree, for example, that beta-blockers are less effective than other antihypertensive drugs in preventing strokes.

One concern is that guidelines downgrading the value of beta-blockers for hypertension may lead physicians to stop using them in those patients who would benefit from taking them because they have symptomatic angina or have suffered a heart attack.

Other specific recommendations of the British doctors' group are:

• Either a calcium-channel blocker or a thiazide-type diuretic should be the first choice for initial treatment in hypertensive patients who are 55 or older and in black patients of any age.
  
• An ACE inhibitor should be the initial treatment in hypertensive patients younger than 55 years of age.
  
• If blood pressure is already well controlled with a combination of medications that include a beta-blocker, the beta-blocker does not have to be replaced with another medication.
  
• Patients should not stop taking a beta-blocker abruptly. Rather, the dose should be tapered gradually.