Beta blockers should not
remain first treatment for high blood pressure
Newswise — Beta blockers are
not as effective as other drugs that reduce high blood pressure
in patients with hypertension, concludes a meta-analysis
published online today (Tuesday October 18, 2005) by The
Lancet.
More than a quarter of the
world’s adult population, totalling nearly one billion people,
have high blood pressure. For three decades, beta blockers have
been widely used in the treatment of high blood pressure and are
recommended as first-line drugs in several current treatment
guidelines. In the UK, more than 2
million people are treated
with beta-blockers. However, the effectiveness of beta blockers
has recently been challenged. A preliminary study published last
year in The Lancet (Lancet 2004; 364: 1648-89) concluded
that one beta blocker, called atenolol, is less effective than
other drugs at reducing the cardiovascular risks in patients
with high blood pressure.
Lars Hjalmar Lindholm (Umea
University Hospital, Sweden) and colleagues investigated the
effectiveness of atenolol and other beta blockers on stroke,
myocardial infarction, and all-cause mortality. The researchers
combined data from 13 randomised trials, involving over 105,000
people, that compared beta blockers with other antihypertensive
drugs. They found that the risk of stroke was 16% higher with
beta blockers than with other drugs, while all-cause mortality
was 3% higher. However, there was no difference between the
drugs in relation to heart problems. When the team looked at
atenolol separately, the risk of stroke was 26% higher than for
other drugs. In seven other studies involving 27, 500 people,
they also found that when the effect of beta blockers was
compared with that of no treatment, the risk of stroke was
reduced by 19%, which is about half that expected from previous
trials.
Professor Lindholm concludes:
“Switching hypertension treatment from beta blockers to other
low-cost antihypertensive drugs in patients without heart
disease should have a major health effect without increasing the
cost. Such a change, however, should be carried out slowly and
under a doctor’s supervision...In comparison with other
antihypertensive drugs, the effect of beta blockers is clearly
suboptimum with a higher risk of stroke. We therefore believe
that beta blockers should not remain as first choice in the
treatment of primary hypertension.”