Treatments: Front Line Against Hypertension Is Under Siege

Beta blockers, the most commonly used drugs for treating high blood pressure unaccompanied by other cardiovascular disease, are probably less effective than other drugs used for the same purpose, new research says.

The work examines the results of 13 randomized trials and concludes that the drugs, which have been the first-line treatment for hypertension for at least 25 years, produce a higher risk for stroke when compared with other drugs used for the same purpose.

Dr. Lars H. Lindholm, the lead author on the study, which was published in Lancet online on Oct. 18 and in print on Saturday, emphasized that the results pertained only to people who had high blood pressure without other heart problems.

"What has happened," he said, "is that a drug that was excellent for secondary prevention - that is, in people who suffer from heart disease - has been moved to primary prevention," and is much less effective in that role.

According to the study, beta blockers do work to reduce the risk of stroke but not as well as other medicines, and they are ineffective in preventing heart attack or extending the lives of patients with uncomplicated hypertension.

The review found that the relative risk of stroke was actually 16 percent higher with beta blockers alone than with other blood pressure medicines.

Dr. Lindholm, chairman of the department of public health and clinical medicine at Umea University Hospital in Sweden, warned that patients on beta blockers should not change medicine on their own.

The Times' last sentence was deleted.

"Beta blockers won't harm you," he said.

Unless you have a history of bronchospastic disease, e.g. asthma, chronic obstructive pulmonary disease, use a beta₂ agonist, etc., then check the precautions and beware of possible adverse reactions.

The Lancet 2005; 366:1545-1553

DOI:10.1016/S0140-6736(05)67573-3

Should β(beta) blockers remain first choice in the treatment of primary hypertension? A meta-analysis Lars Hjalmar Lindholm a , Bo Carlberg a and Ola Samuelsson b

Summary 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.

Affiliations

a Department of Public Health and Clinical Medicine, Umeå University Hospital, Umeå, Sweden b Department of Nephrology, Sahlgrenska University Hospital, Göteborg, Sweden

Correspondence to: Prof Lars H Lindholm, Department of Public Health and Clinical Medicine, Umeå University Hospital, SE 901 85 Umeå, Sweden

Now I'm confused - Beta Blockers won't harm you but they are not as effective as other drugs?

Any drug can harm you. So can too much or too little oxygen or water.

That being said, this meta-analysis, i.e. pooling of the results of multiple clinical trials, showed that with respect to the prevention of stroke, other types of anti-hypertensive agents were more effective than beta blockers.

The choice of which drug to use for treating simple, uncomplicated hypertension is straightforward. The current standard of care is to start on a thiazide diuretic. Years ago, either a beta blocker or a thiazide diuretic was standard of care. Once you have any other diagnosis besides hypertension, it can become extremely complicated.

Here are some links sponsored by the gov't. The latter is intended for the general public.

Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.

High Blood Pressure

Unless you have some specific questions, ask your doc. P.S. I can't type besides hunt and peck.

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