Beta-Blockers and Exercise

  • Bangalore S
  • Messerli F
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<br />Earlier studies have shown that beta-blockers bring about a clear reduction in exercise endurance in young healthy subjects (2-3) and trained sportsmen (4-5). Similarly, in patients with hypertension who are on beta-blockers, the reduction in exercise tolerance in part could be attributable to be secondary to these drugs (6). In the study by Kokkinos et al. (1), both the exercise duration and the total metabolic equivalents achieved were significantly lower in the group on beta-blockers compared to other medications. In the ASCOT–BPLA (Anglo-Scandinavian Cardiac Outcome Trial–Blood Pressure Lowering Arm) study of 19,257 patients with hypertension and at least three other coronary risk factors but no coronary artery disease, atenolol-based treatment resulted in a 14% higher risk of coronary events and a 23% increase in stroke rate compared to amlodipine-based regimen (7). In a recent meta-analysis of 134,000 patients on antihypertensive therapy, beta-blocker treatment was associated with a 16% higher incidence of stroke compared to other antihypertensive treatments (8). Of note, beta-blockers have recently been shown to differ in their effect on central aortic BP compared to peripheral brachial pressure. The Conduit Artery Functional Endpoint (CAFÉ trial) and other studies have documented that beta-blockers have a lesser effect on central systolic pressure than do angiotensin-converting enzyme (ACE) inhibitors, diuretics, and calcium antagonists (9-11). In fact, results of the CAFÉ (12) study show that a calcium antagonist–based treatment is much more effective at reducing central aortic BP than is a conventional atenolol-based (beta-blocker) regimen. Importantly, the study also suggests that the central aortic BP may be more predictive of cardiovascular events, such as stroke and myocardial infarction, than traditional peripheral (brachial) BP measurements (12).<br />




Bangalore, S., & Messerli, F. H. (2006). Beta-Blockers and Exercise. Journal of the American College of Cardiology, 48(6), 1284–1285.

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