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β-blockers: No longer an option for uncomplicated hypertension

  • Hypertension
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Abstract

Traditionally, β-blockers, used as first-line agents to treat uncomplicated hypertension, were recommended by national and international guidelines despite a paucity of evidence regarding their cardiovascular benefit. However, evidence from recent trials and metaanalyses has questioned the use of β-blockers as preferred agents. This article reviews the data available from clinical trials and argues that β-blockers are less efficacious than other currently available antihypertensive agents for patients with uncomplicated hypertension.

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References and Recommended Reading

  1. Hajjar I, Kotchen TA:Trends in prevalence, awareness, treatment, and control of hypertension in the United States, 1988–2000.JAMA 2003,290:199–206.

    Article  PubMed  Google Scholar 

  2. Cook NR, Cohen J, Hebert PR, et al.:Implications of small reductions in diastolic blood pressure for primary prevention.Arch Intern Med 1995,155:701–709.

    Article  PubMed  CAS  Google Scholar 

  3. Bangalore S, Messerli FH:Hypertension in the elderly: a compelling contraindication for beta-blockers? J Hum Hypertens 2007,21:259–260.

    PubMed  CAS  Google Scholar 

  4. Berenson A:Big drug makers see sales decline with their image.New York Times. November 14, 2005.

  5. Kalinowski L, Dobrucki LW, Szczepanska-Konkel M, et al.:Third-generation beta-blockers stimulate nitric oxide release from endothelial cells through ATP efflux: a novel mechanism for antihypertensive action.Circulation 2003,107:2747–2752.

    Article  PubMed  CAS  Google Scholar 

  6. European Society of Hypertension-European Society of Cardiology Guidelines Committee:2003 European Society of Hypertension-European Society of Cardiology guidelines for the management of arterial hypertension,J Hypertens 2003,21:1011–1053.

    Article  Google Scholar 

  7. Chobanian AV, Bakris GL, Black HR, et al.:The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report.JAMA 2003,289:2560–2572.

    Article  PubMed  CAS  Google Scholar 

  8. Williams B, Poulter NR, Brown MJ, et al.:British Hypertension Society guidelines for hypertension management 2004 (BHS-IV): summary.BMJ 2004,328:634–640.

    Article  PubMed  Google Scholar 

  9. SHEP Cooperative Research Group: Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension: final results of the Systolic Hypertension in the Elderly Program (SHEP).JAMA 1991,265:3255–3264.

    Article  Google Scholar 

  10. Dahlöf B, Lindholm LH, Hansson L, et al.:Morbidity and mortality in the Swedish Trial in Old Patients with Hypertension (STOP-Hypertension).Lancet 1991,338:1281–1285.

    Article  PubMed  Google Scholar 

  11. Hansson L, Lindholm LH, Ekbom T, 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 1999,354:1751–1756.

    Article  PubMed  CAS  Google Scholar 

  12. Black HR, Elliott WJ, Grandits G, et al.:Principal results of the Controlled Onset Verapamil Investigation of Cardiovascular End Points (CONVINCE) trial.JAMA 2003,289:2073–2082.

    Article  PubMed  CAS  Google Scholar 

  13. Hansson L, Hedner T, Lund-Johansen P, et al.:Randomised trial of effects of calcium antagonists compared with diuretics and beta-blockers on cardiovascular morbidity and mortality in hypertension: the Nordic Diltiazem (NORDIL) study.Lancet 2000,356:359–365.

    Article  PubMed  CAS  Google Scholar 

  14. Hansson L, Lindholm LH, Niskanen L, et al.:Effect of angiotensin-converting-enzyme inhibition compared with conventional therapy on cardiovascular morbidity and mortality in hypertension: the Captopril Prevention Project (CAPPP) randomised trial Lancet 1999,353:611–616.

    Article  PubMed  CAS  Google Scholar 

  15. MRC Working Party:Medical Research Council trial of treatment of hypertension in older adults: principal results.BMJ 1992,304:405–412.

    Article  Google Scholar 

  16. Lever AF, Brennan PJ:MRC trial of treatment in elderly hypertensives.Clin Exp Hypertens 1993,15:941–952.

    Article  PubMed  CAS  Google Scholar 

  17. Dahlöf B, Sever PS, Poulter NR, 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 2005,366:895–906.

    Article  PubMed  CAS  Google Scholar 

  18. Devereux RB, Dahlöf B, Gerdts E, et al.:Regression of hypertensive left ventricular hypertrophy by losartan compared with atenolol: the Losartan Intervention for Endpoint Reduction in Hypertension (LIFE) trial Circulation 2004,110:1456–1462.

    Article  PubMed  CAS  Google Scholar 

  19. Of importance Lindholm LH, Carlberg B, Samuelsson O:Should beta blockers remain first choice in the treatment of primary hypertension? A meta-analysis.Lancet 2005,366:1545–1553. A meta analysis that evaluated the role of β-blockers in hypertension.

    Article  PubMed  CAS  Google Scholar 

  20. Wiysonge CS, Bradley H, Mayosi BM, et al.: Beta-blockers for hypertension.Cochrane Database Syst Rev 2007: CD002003.

  21. Collins R, Peto R, MacMahon S, 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 1990,335:827–838.

    Article  PubMed  CAS  Google Scholar 

  22. Dahlöf B, Devereux RB, Kjeldsen SE, et al.:Cardiovascular morbidity and mortality in the Losartan Intervention for Endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol.Lancet 2002,359:995–1003.

    Article  PubMed  Google Scholar 

  23. Messerli FH, Grossman E, Goldbourt U:Are beta-blockers efficacious as first-line therapy for hypertension in the elderly? A systematic review.JAMA 1998,279:1903–1907.

    Article  PubMed  CAS  Google Scholar 

  24. Hirata K, Vlachopoulos C, Adji A, O’Rourke MF:Benefits from angiotensin-converting enzyme inhibitor “beyond blood pressure lowering”: beyond blood pressure or beyond the brachial artery? J Hypertens 2005,23:551–556.

    Article  PubMed  CAS  Google Scholar 

  25. Morgan T, Lauri J, Bertram D, Anderson A:Effect of different antihypertensive drug classes on central aortic pressure.Am J Hypertens 2004,17:118–123.

    Article  PubMed  CAS  Google Scholar 

  26. Williams B, Lacy PS, Thom SM, et al.:Differential impact of blood pressure-lowering drug on central aortic pressure and clinical outcomes: principal results of the Conduit Artery Function Evaluation (CAFE) study Circulation 2006,113:1213–1225.

    Article  PubMed  CAS  Google Scholar 

  27. Gress TW, Nieto FJ, Shahar E, et al.:Hypertension and antihypertensive therapy as risk factors for type 2 diabetes mellitus: Atherosclerosis Risk in Communities Study.N Engl J Med 2000,342:905–912.

    Article  PubMed  CAS  Google Scholar 

  28. Pepine CJ, Handberg EM, Cooper-DeHoff RM, et al.:A calcium antagonist vs a non-calcium antagonist hypertension treatment strategy for patients with coronary artery disease. The International Verapamil-Trandolapril Study (INVEST): a randomized controlled trial.JAMA 2003,290:2805–2816.

    Article  PubMed  CAS  Google Scholar 

  29. Elliott WJ, Meyer PM:Incident diabetes in clinical trials of antihypertensive drugs: a network meta-analysis.Lancet 2007,369:201–207.

    Article  PubMed  CAS  Google Scholar 

  30. Of importance Bangalore S, Parkar S, Grossman E, Messerli F:A meta-analysis of 94,492 patients with hypertension treated with beta-blockers to determine the risk of new onset diabetes mellitus.Am J Cardiol 2007 [in press]. This meta-analysis evaluated the risk of new-onset diabetes with β-blockers used for treatment of hypertension and assessed the predictors of patients at risk for new-onset diabetes while on β-blockers.

  31. Eaton CB, Feldman HA, Assaf AR, et al.:Prevalence of hypertension, dyslipidemia, and dyslipidemic hypertension.J Fam Pract 1994,38:17–23.

    PubMed  CAS  Google Scholar 

  32. Weir MR, Moser M:Diuretics and beta-blockers: is there a risk for dyslipidemia? Am Heart J 2000,139:174–183.

    Article  PubMed  CAS  Google Scholar 

  33. Bradley HA, Wiysonge CS, Volmink JA, et al.:How strong is the evidence for use of beta-blockers as first-line therapy for hypertension? Systematic review and meta-analysis.J Hypertens 2006,24:2131–2141.

    Article  PubMed  CAS  Google Scholar 

  34. Messerli FH, Grossman E:Beta-blocker therapy and depression.JAMA 2002,288:1845–1846.

    Article  PubMed  Google Scholar 

  35. Of major importance National Collaborating Centre for Chronic Conditions:Hypertension: Management of Hypertension in Adults in Primary Care: Partial Update. London: Royal College of Physicians; 2006. The NICE-funded guidelines provide detailed analysis of β-blockers in hypertension compared with different antihypertensive drug classes as well as a very useful cost-effectiveness model.

    Google Scholar 

  36. Khan N, McAlister FA:Re-examining the efficacy of betablockers for the treatment of hypertension: a meta-analysis.CMAJ 2006,174:1737–1742.

    PubMed  Google Scholar 

  37. Kaboli PJ, Shivapour DM, Henderson MS, et al.:Patient and provider perceptions of hypertension treatment: do they agree? J Clin Hypertens 2007,9:416–423.

    Article  Google Scholar 

  38. Celik T, Iyisoy A, Kursaklioglu H, et al.:Comparative effects of nebivolol and metoprolol on oxidative stress, insulin resistance, plasma adiponectin and soluble P-selectin levels in hypertensive patients.J Hypertens 2006,24:591–596.

    Article  PubMed  CAS  Google Scholar 

  39. Bakris GL, Fonseca V, Katholi RE, et al.:Metabolic effects of carvedilol vs metoprolol in patients with type 2 diabetes mellitus and hypertension: a randomized controlled trial.JAMA 2004,292:2227–2236.

    Article  PubMed  CAS  Google Scholar 

  40. Fountoulaki K, Dimopoulos V, Giannakoulis J, et al.:Left ventricular mass and mechanics in mild-to-moderate hypertension: effect of nebivolol versus telmisartan.Am J Hypertens 2005,18:171–177.

    Article  PubMed  CAS  Google Scholar 

  41. Celik T, Yuksel UC, Iyisoy A, et al.:Effects of nebivolol on platelet activation in hypertensive patients: a comparative study with metoprolol.Int J Cardiol 2007,116:206–211.

    Article  PubMed  Google Scholar 

  42. Grassi G, Trevano FQ, Facchini A, et al.:Efficacy and tolerability profile of nebivolol vs atenolol in mild-to-moderate essential hypertension: results of a double-blind randomized multicentre trial.Blood Press Suppl 2003,2:35–40.

    Article  PubMed  CAS  Google Scholar 

  43. Mancia G, De Backer G, Dominiczak A, et al.:2007 Guidelines for the management of arterial hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC).Eur Heart J 2007,28:1462–1536.

    PubMed  Google Scholar 

  44. Rosendorff C, Black HR, Cannon CP, et al.:Treatment of hypertension in the prevention and management of ischemic heart disease: a scientific statement from the American Heart Association Council for High Blood Pressure Research and the Councils on Clinical Cardiology and Epidemiology and Prevention.Circulation 2007,115:2761–2788.

    Article  PubMed  Google Scholar 

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Correspondence to Franz H. Messerli MD.

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Bangalore, S., Kamalakkannan, G. & Messerli, F.H. β-blockers: No longer an option for uncomplicated hypertension. Curr Cardiol Rep 9, 441–446 (2007). https://doi.org/10.1007/BF02938387

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