Thoughts about beta blockers as anti-hypertensive drugs
Semmelweis Egyetem, II. sz. Belgyógyászati Klinika, Budapest
Beta blockers that may be used effectively in various indications have been available for nearly 6 decades. Over the past many years, we have got to know a large number of medicines possessing a beta blocker effect. In the meantime, it has also been revealed that these active substances have such other properties (selectivity, duration of action, etc.), which strongly affect their clinical effect, therapeutic effectivity, rendering them strongly distinct from each other. However, the effects of beta blockers are also influenced by further factors that are taken into consideration to a lesser extent in everyday practice. Thus, for example genetic polymorphism, hydro- and lipophilicity of beta blockers, hepatic metabolism of lipophilic beta blockers, the level of sympathetic nervous system activity, and the level of associated catecholaminaemia. The latter plays a pathogenic role in the development/maintenance of abnormal increase of blood pressure in various pathophysiological conditions. Consequently, targeted and effective inhibition of the abnormally increased sympathoadrenal and renin angiotensin aldosterone system, often secondary to hypertension, can be achieved by a wisely selected beta blocker.