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Evidence against use of Beta blockers as first choice in the treatment of primary hypertension

Beta blockers have been used widely in the treatment of hypertension and are still recommended as first-line drugs in hypertension guidelines. Moreover, after myocardial infarction and in patients with heart failure, treatment // with beta blockers prevents re-infarction, hospitalisation for heart failure, and premature death. However, a preliminary analysis has shown that atenolol is not very effective in hypertension.

A recent study, published in the October-November issue of The Lancet, was conducted with the aim to substantially enlarge previous data on atenolol and analyse the effect of different beta blockers on stroke, myocardial infarction, and mortality of all causes .

For the study, the Cochrane Library and PubMed were searched for beta 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 were included in a meta-analysis comparing treatment with beta blockers with other antihypertensive drugs. Seven studies were included in a comparison of beta blockers and placebo or no treatment..

Results obtained showed that the relative risk of stroke was 16% higher for beta blockers than for other drugs. There was no difference for myocardial infarction. When the effect of beta blockers was compared with that of placebo or no treatment, the relative risk of stroke was reduced by 19% for all beta blockers, about half that expected from previous hypertension trials. There was no difference for myocardial infarction or mortality.

The authors conclude that in comparison with other antihypertensive drugs, the effect of beta blockers is less than optimum, with a raised risk of stroke.

The authors suggest that beta blockers should not remain first choice in the treatment of primary hypertension and should not be used as reference drugs in future randomised controlled tr ials of hypertension.


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