β-Blockade for Patients with Hypertension, Ischemic Heart Disease or Heart Failure: Where are We Now?

β-blockers are a heterogeneous class of drugs, with varying selectivity/specificity for β(1) vs β(2) receptors, intrinsic sympathomimetic activity (ISA), and vasodilatory properties (through β(2) stimulation, α receptor blockade or nitric oxide release). These drugs are indicated for the management of arterial hypertension, heart failure or ischemic heart disease (IHD; eg angina pectoris or prior myocardial infarction). Most of the benefit of β-blockade in these conditions arises from blockade of the β(1) receptor, and, in practice, the addition of ISA appears to reduce the potential for improved clinical outcomes in people with heart failure or IHD. Aspects of the benefit/risk balance of β-blockers remain controversial, and recent meta-analyses have shed new light on this issue. We have reviewed the current place of cardioselective β-blockade in hypertension, IHD and heart failure, with special reference to the therapeutic profile of a highly selective β(1)-adrenoceptor blocker, bisoprolol.