Which of the following should NOT be used as a first-line treatment for hypertension?

Which of the following should NOT be used as a first-line treatment for hypertension?

• A. ACE inhibitors
• B. Thiazide diuretics
• C. Calcium channel blockers
• D. Beta-blockers

Answer: (D)

Beta-blockers are not used as first-line treatment for uncomplicated hypertension because the evidence shows that other classes—thiazide diuretics, ACE inhibitors, ARBs, and calcium channel blockers—reliably reduce cardiovascular events and, in particular, stroke risk when started as initial therapy. Beta-blockers, while important for conditions like coronary artery disease, certain arrhythmias, and heart failure with reduced ejection fraction, have not demonstrated the same level of outcome benefit as first-line monotherapy in patients without these comorbidities. They also carry potential metabolic side effects and can cause bradycardia and fatigue, which can limit tolerability. For those reasons, beta-blockers are reserved for patients with specific accompanying conditions, whereas the other classes are preferred as starting options for most individuals with newly diagnosed hypertension.

Beta-blockers are not used as first-line treatment for uncomplicated hypertension because the evidence shows that other classes—thiazide diuretics, ACE inhibitors, ARBs, and calcium channel blockers—reliably reduce cardiovascular events and, in particular, stroke risk when started as initial therapy. Beta-blockers, while important for conditions like coronary artery disease, certain arrhythmias, and heart failure with reduced ejection fraction, have not demonstrated the same level of outcome benefit as first-line monotherapy in patients without these comorbidities. They also carry potential metabolic side effects and can cause bradycardia and fatigue, which can limit tolerability. For those reasons, beta-blockers are reserved for patients with specific accompanying conditions, whereas the other classes are preferred as starting options for most individuals with newly diagnosed hypertension.