Understanding the Position of Beta-blockers in the Management of Hypertension among Patients with Different Clinical Comorbidities: An Expert Opinion of Cardiologists from India

Background: Elevated blood pressure (BP) increases the risk of cardiovascular mortality, underscoring the vital importance of effective management in individuals with hypertension (HTN) and cardiovascular disease. However, lack of clear guidance on the utilization of the new beta-blockers has caused hesitation among doctors in using them effectively. The objective of this expert opinion was to understand the role and current position of beta-blockers in the management of patients with HTN and different clinical comorbidities. Methods: A collective of 828 cardiologists throughout India were invited to participate in an online survey and virtual meetings. Their clinical insights were gathered on approaches in managing these patients and their understanding of the role of beta-blockers. Results: The panel of experts recommended that in patients with HTN and angina, the BP target should be 130/80 mmHg (40.70%), and the use of a combination of telmisartan and cardio-selective beta-blockers should be used to lower BP (63.29%). A combination of telmisartan and a beta-1 blocker was recommended for effective BP control and structural regression of left ventricular hypertrophy (52.78%). For intensive BP control, combination therapy of telmisartan and beta-blockers should be used in patients with HTN and atrial fibrillation (59.18%). The panel of experts opined (60.02%) that different BP targets should be considered for different stroke subtypes. Telmisartan (44.44%) and selective beta-1 blockers (29.35%) are recommended to manage BP variability in patients with HTN and recurrent stroke. Conclusion: In patients with HTN and cardiovascular disease, individualized decision-making is necessary for beta-blocker use in HTN management. Selective beta-blockers should be considered first-line therapy or combined with telmisartan when indicated.