Role of Beta-Blockers in Hypertension: Learning from the Landmark Indian ROBUST Study

New findings from one of India's largest real-world clinician perception studies highlight the continued clinical relevance of beta-blockers in hypertension management, with metoprolol emerging as the most preferred agent across multiple cardiovascular indications in Indian clinical settings.

Published in the Journal of the Association of Physicians of India in February 2026, the Role of β-Blockers Across the Cardiovascular Continuum: A Real-World Perception Survey (ROBUST) study.

offers significant practical insights into clinical decision-making, therapeutic preferences, and prescribing behaviour concerning the use of β-blockers in hypertension and cardiovascular disease.

This nationwide, cross-sectional survey was conducted among Health-Care Professionals (HCPs) across India, including consulting physicians, cardiologists, and diabetologists. A total of 855 responses (85.5%) were analysed using a structured 26-item questionnaire assessing real-world utilization patterns and clinical perceptions.

Key Findings: Beta-Blockers in Hypertension

• 57.2% of clinicians reported prescribing β-blockers to 25–50% of hypertensive patients, indicating consistent utilization.

• Around 39.8% of HCPs used β-blockers as first-line therapy in patients with compelling indications such as high sympathetic drive or prior cardiovascular disease.

• In patients without compelling indications, 45.4% HCPs limited use to ≤25% cases, reflecting selective and individualized prescribing.

• As second-line therapy, β-blockers were widely used, with 52.4% HCPs prescribing them to 25–50% of patients requiring additional BP control.

• Patient selection patterns showed preference for patients with high resting heart rate (51.5%), high cardiovascular risk (42.2%), and younger hypertensive patients (26.9%), reflecting a shift toward individualized, phenotype-based hypertension management.

Metoprolol Emerges as the Preferred Beta-Blocker

• Metoprolol was identified as the preferred β-blocker for hypertension management by nearly 75% of clinicians. Over half reported clinically meaningful blood pressure reductions of 10-15 mmHg in systolic BP and 5-10 mmHg in diastolic BP, indicating strong confidence in its efficacy.

• Clinicians prefer ARB + β-blocker regimens (53.1%) over CCB-based combinations (39.3%), indicating a treatment approach that prioritizes cardiovascular protection and personalized hypertension management.

These trends reflect a pragmatic strategy to improve BP control, adherence, and overall cardiovascular risk reduction.

Metoprolol: Trusted Across Cardiovascular Indications

Speaking to Medical Dialogues, Dr Sanjib K Sahu, MD, DNB (Cardiology), FACC (USA), FESC, said- "Based on the ROBUST survey, I would say that metoprolol has emerged as the most preferred β-blocker across the cardiovascular continuum because of its broad clinical acceptance, proven efficacy, and favorable safety profile. It was the most preferred β-blocker across major cardiovascular indications, including hypertension (75%), heart failure (66.2%), post-myocardial infarction (78.1%), chronic coronary syndrome (82.7%), and atrial fibrillation for rate control (85.4%). The clinical survey also showed meaningful blood pressure reduction, with clinicians reporting a 10–15 mmHg reduction in systolic blood pressure in 50.2% of patients and a 5–10 mmHg reduction in diastolic blood pressure in 54.4% of patients. It also has a strong evidence-based role across the cardiovascular continuum, including hypertension, heart failure, post-MI, CCS, and AF. Its favorable β1-cardioselectivity contributes to clinician confidence, particularly in patients where respiratory safety is a consideration. In my opinion, the extensive clinical experience and widespread acceptance among Indian cardiologists reflect its consistent efficacy, tolerability, and alignment with guideline-directed therapy."

Conclusion

The ROBUST study provides compelling real-world evidence that β-blockers, particularly metoprolol, remain an important component of hypertension management in India. Their selective use in patients with elevated heart rate, higher cardiovascular risk, and specific clinical indications highlights a transition toward individualized, physiology-driven treatment strategies.

Abbreviations: HCP-Health-Care Professional; BP-Blood Pressure; ARB- Angiotensin II Receptor Blocker; CCB- Calcium Channel Blocker; CV- Cardiovascular