Should beta-blockers be used to control hypertension in people with chronic kidney disease?

Activation of the sympathetic nervous system is common in patients with chronic kidney disease, plays an important role in the genesis of hypertension, the rate of decrease of renal function, and is associated with the increased cardiovascular morbidity and mortality seen in these patients. beta-blockers are potent antihypertensive agents but differ in their hemodynamic effects on renal function. The cardioselective beta-blockers such as atenolol and metoprolol are known to retard the progression of renal diseases, but to a lesser degree compared with blockers of the renin-angiotensin-aldosterone system. However, the newer vasodilating beta-blockers such as carvedilol and nebivolol have different effects on renal hemodynamics and function primarily because of its greater adjunctive alpha1-blocking activity. Carvedilol decreases renal vascular resistance and prevents reductions in the glomerular filtration rate and renal blood flow in patients with hypertension with or without impaired kidney function. In addition, carvedilol may retard progression of albuminuria, and provide cardiorenal protection in chronic kidney disease patients with hypertension, congestive heart failure, and at high risk for sudden cardiac death.