Should β blockers remain first choice in the treatment of primary hypertension? A meta-analysis
LH Lindholm, B Carlberg, O Samuelsson - The Lancet, 2005 - thelancet.com
LH Lindholm, B Carlberg, O Samuelsson
The Lancet, 2005•thelancet.comBackground β 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 β blockers.
Methods The Cochrane Library and PubMed were searched for β blocker treatment in
patients with primary hypertension. Data were then entered into the Cochrane Collaboration …
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 β blockers.
Methods The Cochrane Library and PubMed were searched for β blocker treatment in
patients with primary hypertension. Data were then entered into the Cochrane Collaboration …
Background
β 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 β blockers.
Methods
The Cochrane Library and PubMed were searched for β 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 β blockers with other antihypertensive drugs. Seven studies (n=27 433) were included in a comparison of β blockers and placebo or no treatment.
Findings
The relative risk of stroke was 16% higher for β blockers (95% CI 4–30%) than for other drugs. There was no difference for myocardial infarction. When the effect of β blockers was compared with that of placebo or no treatment, the relative risk of stroke was reduced by 19% for all β blockers (7–29%), about half that expected from previous hypertension trials. There was no difference for myocardial infarction or mortality.
Interpretation
In comparison with other antihypertensive drugs, the effect of β blockers is less than optimum, with a raised risk of stroke. Hence, we believe that β 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.
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