Beta-blockers are first-line therapy for the management of stable angina. They have been shown to be more effective than oral nitrates and calcium antagonists. They reduce the recurrence of chest pain in more than 66% of patients. Many patients with angina manifest little pain, but they may have several episodes of ischemia during the day or night.These episodes can be adequately suppressed by the use of beta-blocking drugs (see the chapter Angina). In patients with unstable angina these drugs are used immediately with aspirin when the patient arrives in the emergency room.
B. Acute Myocardial Infarction
Beta-blockers are strongly recommended as therapy for acute myocardial infarction and are administered within minutes of arrival in the emergency room to virtually all patients who present with acute chest pain believed to be caused by a heart attack. As soon as an ECG confirms the diagnosis, an aspirin, a beta-blocker, and a thrombolytic agent are administered. In patients with acute myocardial infarction beta-blockers have been shown to prevent cardiac death and reduce infarct size. In these patients, beta-blockers are often continued for several years (see Fig. 2).
C. Hypertension
Beta-blockers and diuretics remain first-line agents for the management of virtually all patients with hypertension. Beta-blockers are the drugs of choice in younger and older white patients. Contrary to the opinion of some experts, beta-blockers have been proven effective in older white patients. Beta-blockers are particularly indicated in all individuals with hypertension and concomitant coronary artery disease, diabetes, or dyslipidemia. They are indi¬cated for hypertension in younger African-Americans; they appear to be less effective in older patients of African origin. (see the chapter Hypertension). Beta blockers are also indicated in hypertensive patients with mild-to-moderate heart failure.

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