Expert Panel Reaffirms Beta-blockers as First-Line Therapy for Hypertension in India
India: An expert panel in India came together to develop a consensus on the role of beta-blockers in managing hypertension. The Indian consensus, published in the Journal of the Association of Physicians of India (JAPI), developed graded recommendations regarding the clinical role of beta-blockers in managing hypertension (HTN), HTN with additional cardiovascular (CV) risk, and type 2 diabetes mellitus (T2DM).
Hypertension, a condition affecting millions worldwide, remains a significant health challenge, especially in India, where early cardiovascular disease (CVD) is a growing concern. Despite advances in treatment, the management of essential hypertension continues to be difficult, with control achieved in fewer than 1 in 10 cases, particularly when aligned with updated guidelines from the American College of Cardiology (ACC) and the International Society of Hypertension (ISH). In response to these challenges, the positioning of beta-blockers, particularly nebivolol, has evolved, with a focus on their relevance to the Indian population's unique characteristics, including premature CVD, fragile coronary architecture, and high resting heart rates.
Consensus on the Role of Beta-blockers in Hypertension Treatment
- First-line TreatmentBeta-blockers are classified as first-line drugs for the treatment of hypertension (HTN).
- 94% of respondents stated that the updated ESH HTN guidelines (2023) have increased confidence in using beta-blockers for HTN management.
- Beta-blockers in Comorbid ConditionsBeta-blockers are recommended in the treatment of HTN, particularly for patients with comorbid conditions such as myocardial infarction (MI), heart failure with reduced ejection fraction (HFrEF), and atrial fibrillation (AF).
- They are also beneficial in patients with high resting heart rates, providing additional protection.
- High Resting Heart RatesBeta-blockers should be prescribed to patients with HTN who have high resting heart rates, including younger hypertensives under the age of 40.
- Resting Heart Rate and Blood PressureIn the general population, resting heart rate is a significant predictor of blood pressure and mortality risk.
- Beta-blockers are recommended for patients under 60 years of age with HTN, regardless of the presence of comorbid diseases.
- Nebivolol in Hypertensive Patients with DiabetesNebivolol is the most preferred beta-blocker for hypertensive patients with diabetes.
- Other commonly preferred options include bisoprolol and metoprolol.
- Beta-blockers in COPD and HTNNebivolol is the preferred beta-blocker for patients with both chronic obstructive pulmonary disease (COPD) and HTN due to its favorable side effect profile.
- Nebivolol + ARB CombinationThe combination of nebivolol and angiotensin receptor blockers (ARBs) can be considered in:
- Patients who do not respond well to ARB monotherapy
- Hypertensive patients with diabetes
- Patients with HTN and ischemic heart disease (IHD), particularly those experiencing angina or myocardial infarction (MI).
"The consensus firmly places beta-blockers, especially nebivolol, at the forefront of hypertension treatment in India. The findings support their use in various patient subsets, including those with high resting heart rates, younger hypertensives, and patients with comorbid conditions like T2DM and COPD. Given the unique health challenges in India, these updated recommendations provide a comprehensive approach to managing hypertension, ensuring better long-term outcomes for patients," the researchers concluded.
Reference:
Mohan JC, Roy DG, Ray S, et al. Position of Beta-blockers in the Treatment of Hypertension Today: An Indian Consensus. J Assoc Physicians India 2024;72(10):83-90.
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