β—Blockers vs Calcium Channel Blockers vs ACE Inhibitors

Summary

The use of β—blockers in therapeutics is well established. This article poses 3 questions: (a) what are the particular advantages of β—blockers, and are these important? (b) what problems are caused by β—blockers, and how serious are these? (c) is it possible to maximise the benefits and minimise the unwanted effects by choosing a particular β—blocker or a specific pharmaceutical formulation? The first question is barely addressed but the other two are discussed by reviewing methods for assessing quality of life in the specific field of hypertension, and examining the association between adverse effects of β—blockers and their physicochemical and pharmacodynamic properties. There is an interesting section contrasting the severity and nature of adverse effects in different populations. The tolerability of β—blockers demonstrated in large trials after myocardial infarction provides a contrast with the numerous measures of impaired performance detectable in healthy volunteers. There is also a suggestion that β—blockers are tolerated more readily by patients with type A personalities. The influence of plasma concentration on adverse effects is mentioned briefly, with some support for using a controlled release formulation to reduce fluctuation and adverse effects at peak concentrations. The authors conclude that hydro/lipophilicity is of minor importance, but β₁—selectivity may have some impact on quality of life, and β₁—selective agents are equivalent to calcium channel blockers and ACE inhibitors but (implicitly) superior to nonselective β—blockers.