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ß-Blockers: Still Recommended for Uncomplicated Hypertension?
A meta-analysis suggests that other antihypertensive drugs can be more effective for patients without heart disease.
ß-blockers are important in treating myocardial infarction and congestive heart failure, but their role in treating hypertension has become controversial. Last year, a meta-analysis showed that atenolol was no more effective than other antihypertensive drugs in lowering blood pressure or preventing MIs and was less effective than other drugs in preventing all-cause mortality and stroke (Journal Watch Nov 23 2004). Now these authors have broadened their meta-analysis to include randomized trials of any ß-blocker compared with other drugs, no treatment, or placebo in patients with primary hypertension.
In 13 trials in which ß-blockers (primarily atenolol) were compared with other drugs, the relative risk for stroke was 16% higher with ß-blockers, and no significant differences were found in risk for all-cause mortality or MI. In seven studies in which various ß-blockers were compared with placebo or no treatment, risk for stroke was 19% lower with ß-blockers, about half the reduction in risk seen in earlier trials using ß-blockers and diuretics; patients taking ß-blockers had no significant reductions in risk for all-cause mortality or MI.
Comment: Although this analysis did not control for medication dosages, BP reduction, or funding sources of the component trials, the authors and an editorialist argue strongly that ß-blockers are less effective than other drugs for primary hypertension and should no longer be considered first-line therapy. They suggest that most hypertensive patients without heart disease who are taking ß-blockers be switched carefully to other inexpensive antihypertensive drugs and that clinical guidelines be revised accordingly.
— Bruce Soloway, MD
Published in Journal Watch General Medicine December 9, 2005
Citation(s):
Lindholm LH et al. Should ß blockers remain first choice in the treatment of primary hypertension? A meta-analysis. Lancet 2005 Oct 29; 366:1545-53.
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Beevers DG. The end of ß blockers for uncomplicated hypertension? Lancet 2005 Oct 29; 366:1510-2.
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