Clinical inquiries. Are there big differences among beta-blockers in treating essential hypertension?

Yes, a number of beta-blockers are effective in lowering blood pressure (strength of recommendation [sor]: a, multiple, consistent randomized controlled trials [rCTs]). Cardioselective beta-blockers do not alter lung function studies for patients with chronic obstructive pulmonary disease (CopD) or reversible airway disease (sor: a, meta-analysis of rCTs). propranolol and timolol have greater risks of causing fatigue as a side effect (sor: a, meta-analysis of rCTs). recent meta-analyses have stirred debate on the effectiveness of the agents in preventing adverse outcomes. The level of evidence has reached the point where the practice of using beta-blockers as monotherapy should be questioned (sor: c, expert opinion).