, Volume 8, Issue 6, pp 513–523 | Cite as

Selective versus Nonselective β Adrenoceptor Antagonists in Hypertension

  • Luc M. A. B. Van Bortell
  • Andre J. H. A. Ament
Review Article


The application of cost-effectiveness methodology is particularly important in widespread diseases such as hypertension. However, because prospective costeffectiveness analyses comparing different antihypertensive drugs are not currently available, differences in the cost effectiveness of these drugs can only be estimated. The purpose of this review is to estimate and compare the costs of drug therapy with selective and nonselective β adrenoceptor antagonists in hypertension.

The global costs of antihypertensive treatment are largely determined by drug costs. In most countries, drug costs do not appear to vary substantially between β1-selective and nonselective β-blockers.

The adverse sequelae of hypertension include stroke, myocardial infarction, cardiac hypertrophy and renal failure. There are no obvious differences in effect on stroke and cardiac hypertrophy between β1-selective and nonselective β-blockers. However, compared with β1-selective antagonists, nonselective drugs might be less effective in preventing myocardial infarction in smokers and may impair renal function in patients with both increased peripheral resistance and declining cardiac output.

There is a clear difference between β1-selective and nonselective β-blockers on quality-of-life (QOL) perception. During treatment with nonselective β-blockers, QOL perception is lower than during treatment with β1-selective drugs. Preservation of quality of life during long term antihypertensive treatment deserves considerable weight in economic analyses. Consequently, the more favourable effects of β1-seIective agents on quality of life may outweigh the possible higher costs of these drugs, and suggest that β1-selective agents may be more cost effective than nonselective β-blockers.


Propranolol Atenolol Cardiac Hypertrophy Betaxolol Cilazapril 
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Copyright information

© Springer International Publishing AG 1995

Authors and Affiliations

  • Luc M. A. B. Van Bortell
    • 1
  • Andre J. H. A. Ament
    • 2
  1. 1.Department of Pharmacology, Cardiovascular Research InstituteUniversity of LimburgMaastrichtThe Netherlands
  2. 2.Department of Health Economics, Cardiovascular Research InstituteUniversity of LimburgMaastrichtThe Netherlands

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