Clinical Question:
Are beta-blockers more effective than other drugs in preventing stroke and
myocardial infarction in patients with primary hypertension?
Bottom Line:
In comparison with other antihypertensive drugs, the effect of beta blockers
is less than optimum, with a raised risk of stroke. Hence, we believe that
beta blockers should not remain first choice in the treatment of primary
hypertension and should not be used as reference drugs in future randomised
controlled trials of hypertension.
Reference:
Lindholm LH, Carlberg B, Samuelsson O. Should beta blockers remain first
choice in the treatment of primary hypertension? A meta-analysis. Lancet
2005; 366:1545-53.
Study Design:
Meta-analysis (randomized controlled trials)
Synopsis:
Beta blockers have been used widely in the treatment of hypertension and are
recommended as first-line drugs in hypertension guidelines. However, a
preliminary analysis has shown that atenolol is not very effective in
hypertension. We aim to substantially enlarge the data on atenolol and
analyse the effect of different beta blockers. The Cochrane Library and
PubMed were searched for beta blocker treatment in patients with primary
hypertension. Data were then entered into the Cochrane Collaboration Review
Manager package and were summarised in meta-analyses. 13 randomised
controlled trials (n=105 951) were included in a meta-analysis comparing
treatment with beta blockers with other antihypertensive drugs. Seven
studies (n=27 433) were included in a comparison of beta blockers and
placebo or no treatment. The relative risk of stroke was 16% higher for beta
blockers (95% CI 4-30%) than for other drugs. There was no difference for
myocardial infarction. When the effect of beta blockers was compared with
that of placebo or no treatment, the relative risk of stroke was reduced by
19% for all beta blockers (7-29%), about half that expected from previous
hypertension trials. There was no difference for myocardial infarction or
mortality. |