Beta-blockers are no longer first line treatment for hypertension

Patient

Q: This question is for a cardiologist. What would you recommend for blood pressure medicine for first timeusers. My blood pressure seems to spike when I go to the doctor and basically it is 120.80 to 139/ 84 at home most days. The doctor put me on Meteprolol which is helping me sleep well and feel so much calmer. I have a new option now of taking Hydrochlorothiazide. I am just confused and concerned. So my question really is which one would have the least long term side effects on my body?

Doctor

A:   I would initially recommend a 24 hour ambulatory BP monitor to measure your blood pressure throughout the day, to see if hypertension (high blood pressure defined as >140/90mmHg) is consistently present. Hypertension treatment guidelines follow the ACD rule. In someone of your age, initial therapy could be with either a Calcium channel blocker or Diuretic (Hydrochlorothiazide). Beta-blockers are no longer first line but may be used as additional therapy usually if a patient has angina, history of previous heart attack or heart failure. I would recommend discussing these options with your family doctor, in addition to lifestyle modifications.

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