Beta-blockers in hypertension increase risk of CVS events

HEART rate reduction with beta-blockers increases the risk of cardiovascular events and death in patients with hypertension, a study has confirmed.

The US meta-analysis examined the findings of nine randomised controlled trials, including 34,096 patients randomised to receive beta-blockers, compared with 30,139 receiving other antihypertensives and 3987 patients on placebo.

It found those in the beta-blocker group had a greater risk for all-cause mortality, cardiovascular mortality, myocardial infarction, stroke and heart failure.

An accompanying editorial said the results added another “post-mortem explanation” for the fall in favour of beta-blockers.

“Beta-blockers will surely remain as indicated for heart failure, for after myocardial infarction and for tachyarrhythmias, but no longer for hypertension in the absence of these compelling indications,” the editorial said.

Professor David L. Hare, senior cardiologist at Austin Health in Melbourne, said: “There has been available data over many years that beta-blockers are not as good as other medications in treating uncomplicated hypertension... and that there are slightly more cardiovascular events in the beta-blocker strategies, compared with other strategies.”

Professor of cardiology Ben Freedman, from the University of Sydney and Concord Hospital, agreed that the research indicated GPs should not prescribe atenolol – the most commonly used beta-blocker in the trials – in hypertensive patients.

“It definitely puts a cloud on beta-blockers in hypertension and it puts a big cloud on atenolol for hypertension,” he said.

However, he didn’t believe the non-cardioprotective effect of atenolol could necessarily be extrapolated to all beta-blockers.

“This may be a problem of atenolol; there is some experimental evidence that, even in the ß1-selective blockers, metoprolol has a different profile of cardioprotection after infarction than atenolol, being more effective.”

J Am Coll Cardiol 2008; 52:1482-89, 1490-91.