Abstract：
The benefits of improved clinical outcomes through blood pressure (BP) reduction have been proven in multiple clinical trials and meta-analyses. The new (2023) guideline from the European Society of Hypertension (ESH) includes β-blockers within five main classes of antihypertensive agents suitable for initiation of antihypertensive pharmacotherapy and for combination with other antihypertensive agents. This is in contrast to the 2018 edition of ESH guidelines that recommended β-blockers for use primarily in patients with compelling indications such as cardiovascular comorbidities, e.g. coronary heart disease, heart failure. This change was based on the fact that the magnitude of BP reduction is the most important factor for adverse cardiovascular outcomes, over and above the precise manner in which reduced BP is achieved. The ESH guideline also supports the use of β-blockers for patients with resting heart rate (>80 bpm); high resting heart rate is a sign of sympathetic overactivity, an important driver of adverse cardiac remodelling in the setting of hypertension and heart failure. Hypertension management guidelines support for the use of combination therapies for almost all patients with hypertension, ideally within a single-pill combination to optimise adherence to therapy. Where a β-blocker is prescribed, the inclusion of a dihydropyridine calcium channel blocker within a combination regimen is rational. These agents together reduce both peripheral and central BP, which epidemiological studies have shown is important for reducing the burden of premature morbidity and mortality associated with uncontrolled hypertension, especially strokes.
摘要：
通过降低血压（BP）改善临床结果的益处已在多项临床试验和荟萃分析中得到证实。欧洲高血压学会（ESH）的新（2023年）指南将β受体阻滞剂纳入了五种主要类型的抗高血压药，适用于开始抗高血压药物治疗并与其他抗高血压药联合使用。这与2018年版的ESH指南相反，该指南建议β受体阻滞剂主要用于具有令人信服的适应症（如心血管合并症）的患者。如冠心病,心力衰竭.这一变化是基于以下事实：血压降低的幅度是心血管不良结局的最重要因素。超越了实现降低BP的精确方式。ESH指南还支持静息心率（>80bpm）的患者使用β受体阻滞剂；高静息心率是交感神经过度活动的标志，在高血压和心力衰竭的背景下，不良心脏重塑的重要驱动因素。高血压管理指南支持对几乎所有高血压患者使用联合疗法，理想情况下，在一个单一的药丸组合，以优化坚持治疗。如果开了β受体阻滞剂，在联合治疗方案中加入二氢吡啶类钙通道阻滞剂是合理的.这些药物一起降低外周和中枢血压，流行病学研究表明，这对于减少与不受控制的高血压相关的过早发病率和死亡率的负担很重要，尤其是中风。
