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Beta Blockers Compared with Other Drug Options for the Treatment of Hypertension

 

Am Fam Physician. 2018 Feb 1;97(3):online.

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Details for This Review

Study Population: Nonpregnant adults with hypertension who have been treated for at least one year with a beta blocker

Efficacy End Points: Reduction in incidence of mortality, stroke, coronary heart disease, or total cardiovascular disease

Harm End Points: Mortality, stroke, coronary heart disease, cardiovascular events, or nonadherence due to adverse effects

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BETA BLOCKERS COMPARED WITH OTHER DRUG OPTIONS FOR THE TREATMENT OF HYPERTENSION

Compared with placebo:

1 in 200 had a stroke prevented over five years

1 in 140 had a cardiovascular event prevented over five years

No deaths were prevented

Compared with diuretics:

No strokes, coronary heart disease, cardiovascular events, or overall deaths were prevented

No reported nonadherence due to adverse effects

Compared with renin-angiotensin system inhibitors:

1 in 65 had a stroke

1 in 18 had an adverse effect causing nonadherence

No coronary heart disease, cardiovascular events, or overall deaths were prevented

Compared with calcium channel blockers:

1 in 180 had a stroke

1 in 80 had a cardiovascular event

1 in 200 died

No coronary heart disease was prevented

No reported nonadherence due to adverse effects

BETA BLOCKERS COMPARED WITH OTHER DRUG OPTIONS FOR THE TREATMENT OF HYPERTENSION

Compared with placebo:

1 in 200 had a stroke prevented over five years

1 in 140 had a cardiovascular event prevented over five years

No deaths were prevented

Compared with diuretics:

No strokes, coronary heart disease, cardiovascular events, or overall deaths were prevented

No reported nonadherence due to adverse effects

Compared with renin-angiotensin system inhibitors:

1 in 65 had a stroke

1 in 18 had an adverse effect causing nonadherence

No coronary heart disease, cardiovascular events, or overall deaths were prevented

Compared with calcium channel blockers:

1 in 180 had a stroke

1 in 80 had a cardiovascular event

1 in 200 died

No coronary heart disease was prevented

No reported nonadherence due to adverse effects

Narrative: Hypertension is one of the leading causes of disability and contributors to early death worldwide.1 Beta blockers have been shown to have a mortality benefit in persons with heart failure or acute myocardial infarction.25 However, their benefit as a first-line treatment for hypertension is controversial.68 In this 2017 Cochrane review of 13 randomized controlled trials with 91,561 participants, the effectiveness of beta blockers was compared with placebo, diuretics, renin-angiotensin

Author disclosure: No relevant financial affiliations.

References

show all references

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2. Fonarow GC, Abraham WT, Albert NM, et al. Influence of beta-blocker continuation or withdrawal on outcomes in patients hospitalized with heart failure: findings from the OPTIMIZE-HF program. J Am Coll Cardiol. 2008;52(3):190–199.

3. Chatterjee S, Biondi-Zoccai G, Abbate A, et al. Benefits of ß blockers in patients with heart failure and reduced ejection fraction: network meta-analysis [published correction appears in BMJ. 2013;346:f596]. BMJ. 2013;346:f55.

4. Ellis K, Tcheng JE, Sapp S, Topol EJ, Lincoff AM. Mortality benefit of beta blockade in patients with acute coronary syndromes undergoing coronary intervention: pooled results from Epic, Epilog, Epistent, Capture and Rapport Trials. J Interv Cardiol. 2003;16(4):299–305.

5. De Peuter OR, Lussana F, Peters RJ, Büller HR, Kamphuisen PW. A systematic review of selective and non-selective beta blockers for prevention of vascular events in patients with acute coronary syndrome or heart failure. Neth J Med. 2009;67(9):284–294.

6. Khan N, McAlister FA. Re-examining the efficacy of beta-blockers for the treatment of hypertension: a meta-analysis [published correction appears in CMAJ. 2007;176(7):976]. CMAJ. 2006;174(12):1737–1742.

7. Lindholm LH, Carlberg B, Samuelsson O. Should beta blockers remain first choice in the treatment of primary hypertension? A meta-analysis. Lancet. 2005;366(9496):1545–1553.

8. Wiysonge CS, Bradley HA, Volmink J, Mayosi BM, Mbewu A, Opie LH. Beta-blockers for hypertension. Cochrane Database Syst Rev. 2012;(11):CD002003.

9. Wiysonge CS, Bradley HA, Volmink J, Mayosi BM, Opie LH. Beta-blockers for hypertension. Cochrane Database Syst Rev. 2017;(1):CD002003.

10. MRC Working Party. Medical Research Council trial of treatment of hypertension in older adults: principal results. BMJ. 1992;304(6824):405–412.

 

 

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