Beta blockers were the hottest new blood pressure medications when I was in medical school in Sweden in the 70’s. My American pharmacology book, Goodman and Gilman, said they didn’t work. Eventually they became popular here, too.
For a while doctors would choose blood pressure medications based on each patient’s phenotype, fluid pills for people with swollen legs, aldosterone inhibitors for people with low potassium and beta blockers for flushed, hot-tempered (choleric in even more old-fashioned terms) individuals.
For many years now, we have been told to choose blood pressure medications according to “evidence based” guidelines that don’t differentiate between phenotypes.
Today, beta blockers are far down on the favorites list of blood pressure medications, only recommended for patients with heart rhythm problems or a history of a prior heart attack.
A new study, published in the American Journal of Cardiology (subscription only) and reviewed by the Washington Post, has found that during the two hours after an episode of rage, the risk of a heart attack more than doubles, and this risk is blunted by taking beta blockers.
This brings us back to the very old and the very modern idea of personalized medicine and the curious discrediting of phenotype (the overall characteristics of a patient) and the oversimplified glorification of genotype (the belief that everything is determined by our DNA).
I have held on to the belief that blood pressure treatment needs to be individualized, and I have seen too many blood pressure patients boiling over with adrenaline. Why we shouldn’t treat such an obvious appearing disease mechanism always puzzled me.
I suspect our long ago discarded marching orders to look for possible triggers of elevated blood pressure may soon be tomorrow’s new evidence based guideline.
http://www.ajconline.org/article/S0002-9149(13)00896-5/abstract
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