Tehran University of Medical Sciences Journal of Pharmacoeconomics and Pharmaceutical Management 2383-4498 7 1/2 2021 07 20 19 35 Mende Sorato Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran. Majid Davari Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran. Behzad Fatemi Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran. 2020 05 31 2021 07 19 Background: Beta-blockers are preferred anti-hypertensive for patients with compelling indications. Vasodilator beta-blockers are of particular benefit in blood pressure control and other cardio-metabolic components with limited disturbance in metabolic parameters. There is inadequate evidence on the superiority of vasodilator beta-blockers over non-vasodilator beta-blockers in treating hypertension. Therefore, this systematic review aimed to generate evidence on the clinical effects of non-vasodilator and vasodilator beta-blockers in treating hypertension in adults Methods: We searched articles in English published from January 2000 to January 2020 from the following databases: PubMed/Medline, Web of Science, and Google scholar. We considered the following search query: “clinical effectiveness AND vasodilator beta-blockers AND non-vasodilator beta-blockers AND adult hypertension treatment AND clinical trials”. Results: Nine randomized and controlled trials conducted in 3088 adult hypertensive patients were reviewed. All studies agreed on the comparable antihypertensive efficacy of vasodilating and non-vasodilating beta-blockers. Non-vasodilating beta-blockers significantly reduced heart rate, increased blood glucose, blood cholesterol, and triglycerides. Vasodilator beta-blockers were associated with better cardiometabolic risk reduction, better safety, and oxidative stress reduction. Conclusion: The hypertensive efficacy of vasodilating and non-vasodilating beta-blockers were comparable. Vasodilating beta-blockers were associated with better cardiometabolic risk reduction, better safety profile, and better oxidative stress reduction. However, there is insufficient evidence regarding the superiority of vasodilating and non-vasodilator betablockers. Therefore, it is essential to conduct comprehensive clinical trials by involving different ethnic groups to determine the benefit of vasodilator beta-blockers over non-vasodilators for treating hypertension. https://jppm.tums.ac.ir/index.php/jppm/article/view/139 https://jppm.tums.ac.ir/index.php/jppm/article/download/139/64