Pharmacotherapy For Arterial Hypertension And IHD With Beta-Blockers

Cardiovascular diseases remain the leading cause of morbidity and mortality worldwide, accounting for approximately one-third of all deaths annually. Hypertension, dyslipidemia, obesity, and metabolic syndrome are among the most significant modifiable risk factors contributing to the development of coronary heart disease and other cardiovascular complications. β-blockers have occupied a central role in cardiovascular pharmacotherapy for more than five decades, particularly in the management of hypertension, ischemic heart disease, and chronic heart failure. This study aimed to evaluate the role of β-blockers in the treatment of hypertension and coronary heart disease, with special attention to their clinical efficacy, indications, and metabolic effects. Recent large-scale trials have questioned the use of traditional β-blockers, such as atenolol, as first-line therapy for primary hypertension prevention due to comparatively weaker effects on central aortic pressure and cardiovascular outcomes. Consequently, international guidelines have limited their use as initial antihypertensive agents. However, β-blockers remain strongly recommended in specific patient groups, including those with angina pectoris, previous myocardial infarction, heart failure, tachyarrhythmias, glaucoma, and pregnancy. Particular emphasis is placed on the role of sympathetic nervous system activation in hypertension and metabolic disorders. While classical β-blockers may adversely affect carbohydrate and lipid metabolism, newer vasodilatory agents such as metoprolol, carvedilol, and nebivolol demonstrate improved metabolic profiles and reduced impact on central hemodynamics. Nebivolol, in particular, shows minimal negative metabolic effects, making it preferable in patients with metabolic syndrome, obesity, and diabetes mellitus.