Metoprolol and atenolol are first-line antihypertensive agents for uncomplicated hypertension

Summary

Guidelines diverge on whether beta-blockers remain first-line for uncomplicated hypertension. US (JNC 8 2014, ACC/AHA 2017) and UK (NICE NG136 2019) deprioritize beta-blockers in favor of thiazides, ACE inhibitors, ARBs, and calcium channel blockers, citing Lindholm et al. (Lancet 2005) and Cochrane data that atenolol is inferior to other antihypertensives for stroke and all-cause mortality despite similar BP reduction. However, the 2023 ESC/ESH Hypertension Guidelines continue to list beta-blockers among the five major first-line drug classes. Beta-blockers remain clearly first-line for specific compelling indications (HFrEF, post-MI, rate control in AF, certain arrhythmias, angina). The claim that metoprolol or atenolol are "not blood pressure medications" is an oversimplification — they are FDA-approved for hypertension and do lower BP; they are merely not preferred first-line in several guideline bodies for uncomplicated HTN.