Beta-blockers Beta-blockers are one of the most extensively investigated class of agents, having been used to treat hypertension and CVD for over 40 years. Although all beta-blockers are effective at reducing BP, other issues may influence whether they are appropriate in a given patient and which specific drug is chosen, since beta-blockers vary widely in their Specific attention should be paid to beta-blocker accumulation in patients with advanced CKD and to ensuring that the beta-blocker usage is appropriate in targeting a patient s co-morbidities. Dose considerations in CKD patients. In patients with CKD, the accumulation of beta-blockers or active metabolites could exacerbate concentration-dependent side effects such as bradycardic arrhythmias.123 Such accumulation occurs with atenolol and bisoprolol, but not carvedilol, propranolol, Indications for beta-blockers. A consensus report based on evidence reviewed by the Pharmaceutical Subcommittee of the Oregon Health Resources Commission in 2008 gave an update of the indications for use of beta-blockers in non-CKD patients.125 The subcommittee concluded that although no particular beta-blocker had been shown to be more effective in reducing BP or alleviating angina than another, in cases of mild-to-moderate heart failure, biso- prolol, carvedilol, and metoprolol succinate reduced mortal- ity and in cases of severe heart failure, carvedilol and metoprolol succinate reduced mortality. After a recent myocardial infarction, acebutolol, carvedilol, metoprolol tartrate, propranolol and timolol all reduced mortality. A recent systematic review and meta-analysis of beta-blockers endorsed the use of beta-blockers in CKD patients with heart failure but did not provide any definitive specific advice on the their efficacy in preventing mortality, cardiovascular outcomes or renal disease progression in CKD patients without heart failure. Drug combinations. 