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To the Editor: We were disappointed to see the JNC 7 report's outdated admonition that "-blockers should generally be avoided in individuals who have asthma [or] reactive airways disease."¹ Most of the -blockers used in today's clinical practice are cardioselective agents with minimal ₂ effects. These newer agents confer little risk for bronchospasm. Because there is now ample evidence that -blockers save lives in certain subsets of patients with hypertension—such as those with prior myocardial infarction, those undergoing major surgery, and those with congestive heart failure—it is crucial that these medications are not withheld based on outdated fears.

Although large prospective clinical studies are lacking, a recent meta-analysis² of 29 small trials examined the effects of -blockers on pulmonary function among patients with asthma and chronic obstructive pulmonary disease. Implementation of -blocker therapy among such patients appears to be associated with minimal bronchospasm as measured by spirometry, and virtually no . . . [Full Text of this Article]

Daniel J. Brotman, MD; Shaun D. Frost, MD
Department of General Internal Medicine
Cleveland Clinic Foundation
Cleveland, Ohio

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