We address the reasons why, unlike other guidelines, in the 2023 guidelines of the European Society of Hypertension β-blockers (BBs) have been regarded as major drugs for the treatment of hypertension, at the same level as diuretics, calcium channel blockers, and blockers of the renin-angiotensin system. We argue that BBs, (1) reduce blood pressure (the main factor responsible for treatment-related protection) not less than other drugs, (2) reduce pooled cardiovascular outcomes and mortality in placebo-controlled trials, in which there has also been a sizeable reduction of all major cause-specific cardiovascular outcomes, (3) have been associated with a lower global cardiovascular protection in 2 but not in several other comparison trials, in which the protective effect of BBs versus the other major drugs has been similar or even greater, with a slightly smaller or no difference of global benefit in large trial meta-analyses and a similar protective effect when comparisons extend to BBs in combination versus other drug combinations. We mention the large number of cardiac and other comorbidities for which BBs are elective drugs, and we express criticism against the exclusion of BBs because of their lower protective effect against stroke in comparison trials, because, for still uncertain reasons, differences in protection against cause-specific events (stroke, heart failure, and coronary disease) have been reported for other major drugs. These partial data cannot replace global benefits as the main deciding factor for drug choice, also because in the general hypertensive population whether and which type of event might occur is unknown.

中文翻译：

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将 β 受体阻滞剂纳入 2023 年欧洲高血压学会指南主要抗高血压药物的理由

我们阐述了为什么与其他指南不同，在欧洲高血压学会 2023 年指南中，β 受体阻滞剂 (BB) 被视为治疗高血压的主要药物，与利尿剂、钙通道阻滞剂和高血压药物处于同一水平。肾素-血管紧张素系统阻滞剂。我们认为，BBs，（1）降低血压（负责治疗相关保护的主要因素）不低于其他药物，（2）在安慰剂对照试验中降低汇总心血管结局和死亡率，其中也有在 2 项研究中，所有主要病因特异性心血管结局的大幅减少与较低的总体心血管保护作用相关，但在其他几项比较试验中则不然，其中 BB 与其他主要药物的保护作用相似甚至甚至相似更大，在大型试验荟萃分析中，总体获益略小或没有差异，并且当比较扩展到 BB 组合与其他药物组合时，具有类似的保护作用。我们提到 BB 是针对大量心脏和其他合并症的选择性药物，并且我们对排除 BB 表示批评，因为在比较试验中 BB 的预防中风的作用较低，因为由于仍不确定的原因，针对病因的保护存在差异。 - 其他主要药物已报告特定事件（中风、心力衰竭和冠心病）。这些部分数据不能取代全球获益作为药物选择的主要决定因素，还因为在一般高血压人群中是否会发生以及可能发生哪种类型的事件尚不清楚。