- Cardiorespiratory fitness is related
to better outcome in patients with hypertension.
- Beta-blockers, the common
medications used to treat hypertension, are known to reduce aerobic
- A review is being conducted to
understand and determine which beta-blockers impose a lower physical
limitation on physically active patients of hypertension.
or high blood pressure affects around 20% of the world's adult population. Medications like beta-blockers, ACE inhibitors, diuretics
, and calcium channel blockers are used in its treatment. Beta blockers like atenolol
reduce the heart rate and force of contraction, thereby reducing blood pressure in hypertensive individuals.
Many studies over time have revealed that physical activity and cardiorespiratory fitness
are important predictors of outcome in patients with hypertension. On the other hand, beta-blockers reduce the aerobic exercise capacity and interfere with physical fitness. A review is being conducted by a five-member team of the Department of Social Medicine and Public Health, Palacky University in the Czech Republic to determine which beta blocker would have the least effect on physical activity.
Physical Activity is One of the Modifiable Risk
Factors in Hypertension
Hypertension is a condition in which the
arterial blood pressure or the blood pressure in arteries is persistently
higher than normal. A systolic blood pressure above 140 mm of Hg and diastolic
blood pressure above 90 mm of Hg is classified as hypertension.
‘The effect of beta-blockers on aerobic exercise capacity questions the use of the drugs in the management of hypertension and is being reviewed for better understanding.’
predisposes a person to heart diseases. Most cases of hypertension are due to non-specific lifestyle and genetic factors. Therefore, lifestyle modifications like salt restriction, diet changes, and physical activity form an important part of the management of hypertension.
The two properties of beta blockers, decrease in heart rate and force of contraction, cause concern with respect to reduction in exercise capacity and resting metabolic rate
in hypertensive patients. These could limit the physical activity, which is extremely essential in these patients. Therefore, it becomes relevant to evaluate the magnitude of influence of beta-blockers on physical activity and use the findings in determining the ideal beta-blocker for the treatment of physically active patients of hypertension.
Previous Studies Support the Negative Influence of Beta-Blockers On Exercise Capacity.
In a small study conducted in the past, Billeh R. and his team
researched the effect of 50 mg metoprolol and 25 mg carvedilol on 12 healthy
subjects. They found that the peak oxygen consumption reduced with metoprolol
but not with carvedilol.
In another study, Van Bortel and van Baak
compared the effect of 5 mg nebivolol and 100 mg atenolol in healthy
volunteers. Atenolol caused a reduction in peak exercise and endurance while no
such change was observed with nebivolol. It is important to note that the
participants were healthy in both these studies.
The effects of beta-blockers were also
studied in patients with hypertension with cardiac ailments. Nebivolol and
carvedilol were found to show similar effects in patients suffering from
hypertensive heart failure. A randomized double-blind control study with
metoprolol and carvedilol revealed that as metoprolol produced a greater
increase in maximal exercise capacity. When the effects of atenolol and
nebivolol were studied in patients with hypertension and heart failure, nebivolol showed better
improvement in the hemodynamic status.
The systematic review is being conducted by a
team of researchers in the Czech
Republic. The three-step review started with a search to
determine if any other reviews existed in the literature on Cochrane, MEDLINE, and other similar
databases but none was found. This reinforced the need for the same.
The systematic review of existing literature
- Evaluate studies conducted on an adult population of both genders suffering from hypertension.
- Consider studies that assess
effects of treatment of hypertension with a single beta-blocker or in
combination with another drug.
- Survey studies that include the outcome of beta-blockers in relation to physical activity in patients
suffering from hypertension.
- Include both published and
The review shall seek to determine which
beta-blockers allow a patient of hypertension to be physically active without
limiting physical activity. It shall collect data about beta-blockers that
display least physical limitation and are most effective in treating
The analysis will aim at patients of
hypertension. A sub-group analysis shall be used for other associated
co-morbidities. Sub-group analyses will also be used for varied age and gender
characteristics, as well as for other factors. The review, once completed, will
be published in a peer-reviewed journal.
The review will hopefully serve as an
important tool for the physicians while determining the pharmacological
management of hypertension in physically active patients.
- BETA-Adrenoceptor Antagonists (BETA-Blockers)http://www.bhsoc.org/pdfs/therapeutics/Beta-adrenoceptor%20Antagonists%20(Beta-Blockers).pdf
- Effectiveness of β-blockers in physically active patients with
hypertension: protocol of a systematic review; Dagmar Tučková, Miloslav Klugar, Eliška Sovová, Markéta Sovová, Lenka Štégnerová; BMJ Open 2016;6:e010534 doi:10.1136/bmjopen-2015-010534