Reviewing beta blockers for hypertension

Share this article:
Level 2: Mid-level evidence
A recent systematic review reported that greater heart rate reductions associated with beta blocker use (mainly atenolol) for treatment of hypertension appeared to be correlated with increased rates of adverse outcomes (J Am Coll Cardiol. 2008;52:1482-1489). This prompted a review of the information in DynaMed about the use of beta blockers as first-line therapy for hypertension.

A Cochrane review concluded that beta blockers are not indicated as first-line therapy for hypertension (Cochrane Database Syst Rev. 2007;[1]:CD002003). Beta blockers were no better than placebo in prevention of coronary heart disease or mortality, and they had only a very small advantage in prevention of stroke. Patients given beta blockers tended to have worse outcomes than those given other antihypertensive drug classes. Most trials used atenolol, so it is unclear if conclusions apply to other beta blockers. Another systematic review found benefit from beta blockers (compared with placebo) to be limited to younger patients, with no superiority compared with other antihypertensive drug classes in this age group (CMAJ. 2006;174:1737-1742). This same review found beta blockers less effective than other antihypertensive agents in older patients. Thiazide-type diuretics continue to be recommended as the most cost-effective first-line therapy for hypertension (CADTH Health Technology Assessment. 2007:95, and JAMA. 2003;289:2534). Comorbidities, such as congestive heart failure or history of MI, may need to be taken into account in selecting the best medication for initial treatment of hypertension.
Share this article:
You must be a registered member of Clinical Advisor to post a comment.

More in Evidence-Based Medicine

No benefit with arthroscopic surgery for knee OA

No benefit with arthroscopic surgery for knee OA

Arthroscopic partial meniscectomy does not improve degenerative medial meniscus tear symptoms in patients without knee osteoarthritis.

Steroid dose increase after CRS unnecessary to prevent hypotension

Steroid dose increase after CRS unnecessary to prevent ...

No difference in hypotension between low-, high-dose steroids for IBD patients undergoing major colorectal surgery.

Benefits of newer drug-eluting stents in women with CAD

Benefits of newer drug-eluting stents in women with ...

Newer-generation drug-eluting stents reduce MI risk, target revascularization in women with coronary artery disease.