Initially, the Cochrane Library and PubMed were searched for systematic reviews of β blocker treatment in hypertensive patients ((“adrenergic β antagonists” [MeSH Terms] OR “adrenergic β antagonists” [Pharmacological Action] OR β blocker [Text Word]) AND (“hypertension” [MeSH Terms] OR hypertension [Text Word]) AND (“classification” [MeSH Terms] OR systematic [Text Word])) or ((“adrenergic β antagonists” [MeSH Terms] OR “adrenergic β antagonists” [Pharmacological Action] OR beta blocker
ArticlesShould β blockers remain first choice in the treatment of primary hypertension? A meta-analysis
Introduction
For three decades, β blockers have been widely used in the treatment of hypertension and are still recommended as first-line drugs in hypertension guidelines.1, 2 Moreover, after myocardial infarction and in patients with heart failure, treatment with β blockers prevents re-infarction, hospitalisation for heart failure, and premature death.3, 4, 5, 6 The effect of β blockers as a treatment for primary hypertension has been challenged.7, 8 A preliminary analysis has shown that atenolol is not very effective in hypertension.9 To avoid unnecessary harm to patients, the role of other β blockers needs to be investigated. Here, we substantially enlarge the data on atenolol and analyse the effect of different β blockers on stroke, myocardial infarction, and mortality of all causes (n=127 879).
Section snippets
Methods
The eligibility criteria for inclusion in the present meta-analyses were: randomised controlled trial; treatment of primary hypertension; β blocker as first-line antihypertensive drug in at least 50% of all patients in one treatment group; and outcome data for all-cause mortality, cardiovascular morbidity, or both. Data were then entered into the Cochrane Collaboration review manager programme (RevMan version 4.2). Heterogeneity between the studies was assessed with χ2 test and the chosen
Results
We identified 16 studies comparing β blockers with other antihypertensive treatment. Three of these studies were excluded: the large Captopril Prevention Project (CAPPP) study,11 comparing conventional treatment (diuretics and β blockers) with captopril, because the number of patients treated with β blockers was not registered (Lanke J, personal communication); the Metoprolol Atherosclerosis Prevention in Hypertensives (MAPHY) trial (comparing metoprolol with a thiazide diuretic) because that
Discussion
β blocker treatment of patients with primary hypertension was associated with a substantially higher risk of stroke than treatment with other antihypertensive agents. This was the case when all β blockers were analysed together and when the studies with atenolol were analysed separately. There was also a strong tendency in the same direction when the mixed trials were analysed. In the non-atenolol subgroup, documentation was poor, with surprisingly few studies and few clinical events. The
Search strategy and selection criteria
References (47)
- et al.
β-blockers in hypertension – The emperor has no clothes: An open letter to present and prospective drafters of new guidelines for the treatment of hypertension
Am J Hypertens
(2003) - et al.
Atenolol in hypertension: is it a wise choice?
Lancet
(2004) - et al.
Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendroflumethiazide as required, in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA): a multicentre randomised controlled trial
Lancet
(2005) - et al.
Effect of angiotensin-converting-enzyme inhibition compare with conventional therapy on cardiovascular morbidity and mortality in hypertension: the Captopril Prevention Project (CAPPP)
Lancet
(1999) - et al.
Cardiovascular morbidity and mortality in the losartan intervention for endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol
Lancet
(2002) - et al.
Randomised trial of old and new antihypertensive drugs in elderly patients: cardiovascular mortality and morbidity the Swedish Trial in Old Patients with Hypertension-2 study
Lancet
(1999) - et al.
Randomised trial of effects of calcium antagonists compared with diuretics and β blockers on cardiovascular morbidity and mortality in hypertension: the Nordic Diltiazem (NORDIL) study
Lancet
(2000) - et al.
Morbidity and mortality in the Swedish Trial in Old Patients with hypertension (STOP-Hypertension)
Lancet
(1991) - et al.
Blood pressure, stroke, and coronary heart disease. Part 2, Short-term reductions in blood pressure: overview of randomised drug trials in their epidemiological context
Lancet
(1990) - et al.
Cardiovascular protection and blood pressure reduction: a meta-analysis
Lancet
(2001)