β blockers are useful in managing angina and reducing mortality after myocardial infarction and in heart failure. They probably reduce cardiovascular events in high risk surgery and retard the progression of atherosclerosis. In younger patients, β blockers should remain first line antihypertensives, together with diuretics, calcium channel blockers, angiotensin converting enzymes, and adrenergic receptor binders; choice depends on the individual case.

Not all β blockers are equivalent in cardiovascular protective effects, and atenolol seems inferior to other antihypertensive drugs in reducing stroke and total mortality. Recent publications have found that β blockers are less effective than other antihypertensive drugs in preventing cardiovascular outcomes in hypertensive patients.1 2 3 In interpreting the new data, it is important to integrate these new results with previous trials and meta-analyses.