ABSTRACT
There is continued debate over whether monotherapy with beta-blockers is recommended for hypertension and other forms of cardiovascular disease. Several large clinical trials suggest that beta-blockers may not be as effective as other drugs (or drug combinations) in preventing severe cardiovascular events. However, beta-blockers remain widely prescribed for many types of cardiovascular disease, including congestive heart failure, coronary artery disease, angina, arrhythmia, and hypertension. They are often prescribed in combination with other drugs for hypertension and cardiovascular disease, particularly diuretics.
The hemodynamic, metabolic, and ion balance effects of beta-blockers on exercise have been studied extensively. Less information is available on the newer, third-generation drugs, as these drugs have been widely available in the United States only since the early 2000s. The third-generation drugs may have improved profiles of exercise-related effects, but most beta-blockers decrease exercise heart rate, blood pressure, and cardiac output. Beta-blockers make it difficult to use target heart rate effectively as a measure of exercise intensity. In highly fit individuals, beta-blockers may cause bradycardia. Beta-blockers, especially the non-cardioselective beta-blockers, have ergolytic effects on aerobic exercise. They affect lipid utilization and blood sugar regulation, making their use in diabetics restricted. Exercise should still be encouraged for people with cardiovascular disease, even those who are taking beta-blockers, as exercise-dependent improvements in cardiovascular health are still observed.
