• Beta-blockers Don’t Prevent Complications of High Blood Pressure as Effectively as Other Medications

    Beta-blockers are a class of drugs used to treat high blood pressure, or hypertension . They make the heart beat slower and with less force; as a result, blood pressure drops. For years, beta-blockers have been used as a first-line treatment for hypertension, and they are one of the most commonly used drugs for this purpose. Recently, however, two meta-analyses have found beta-blockers to be less effective than other high blood pressure medications for reducing the risk of stroke , heart attack , and death.
    In a study published in the January 24, 2007 online issue of The Cochrane Library , researchers compared cardiovascular outcomes in patients taking beta-blockers versus patients taking no medications, a placebo, or other antihypertensive medications. Their findings suggest that beta-blockers should no longer be used as a first-line treatment for high blood pressure.

    About the Study

    The researchers analyzed data from 13 randomized controlled trials involving 91,561 hypertensive patients. The trials compared beta-blockers to placebo, no treatment, or other antihypertensive medications including diuretics, calcium-channel blockers, angiotensin-converting enzyme (ACE) inhibitors, and angiotensin receptor blockers (ARBs). The treatments were evaluated based on their ability to reduce the risk of death from any cause, stroke, heart attack, cardiovascular death, and total cardiovascular disease. Researchers also compared how well the patients tolerated the various treatments.
    Patients taking beta-blockers had a small, but significant, reduction in stroke risk compared to patients taking a placebo. Beta-blockers resulted in a modest, but statistically significant increased risk of death, and a higher risk of stroke and total cardiovascular disease, compared to calcium-channel blockers. The risk of death was not significantly different for ACE inhibitors or ARBs compared to beta-blockers, but beta-blockers resulted in an increased risk of stroke compared to these medications. Beta-blockers performed similarly to diuretics in terms of stroke, heart attack, all-cause death and cardiovascular disease risk, but patients taking beta-blockers were more likely to discontinue treatment due to side effects.

    How Does This Affect You?

    This meta-analysis supports other recent studies that suggest that beta-blockers should no longer be prescribed as a first-line treatment for high blood pressure.
    That’s not to say, however, that beta-blockers have outlived their usefulness. In addition to its other valuable uses, beta-blockers will continue to be an important supplementary medication for patients whose blood pressure is not sufficiently lowered by other classes of blood pressure medications.
    If you are currently only taking a beta-blocker for high blood pressure, talk to your doctor. If your blood pressure is under good control and you are tolerating the medication well, he or she may not recommend a change at this time. If this is not the case, however, there are many other medications available to manage your hypertension, most of which apparently have significant advantages over beta-blockers.

    RESOURCES

    American Heart Association http://www.americanheart.org

    National Heart, Lung and Blood InstituteNational Institutes of Health http://www.nhlbi.nih.gov

    References

    Wiysonge CS et al. Beta-blockers for hypertension (Cochrane Review). The Cochrane Library . 2007 Jan 24. Issue 1 (available online). Oxford: Update Software.

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