Beta-blockers should not be first choice for high blood pressure
(25 February 2007: VIDYYA MEDICAL NEWS SERVICE) -- Beta-blocker drugs such as Tenormin, Inderal and Lopressor should not be a doctor’s first choice for treating high blood pressure, according to a large new review of studies.
The review, coming on the heels of several similar large reviews, found that beta-blocker users have a slightly higher risk of death and cardiovascular disease than patients who use calcium channel blockers such as Norvasc and Cardizem to manage their blood pressure.
Patients who take diuretics such as hydrochlorothiazide or a group of drugs called RAS inhibitors (brand names include Altace, Lotensin, and Cozaar) have risks similar to those taking beta-blockers.
Dr. Charles Shey Wiysonge of the Ministry of Public Health in Cameroon, who led the new review, said many recent reviews “arrived at similar conclusions — that the available evidence does not support the use of beta-blockers as first-line drugs in the treatment of hypertension.”
The review appears in the latest issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.
Wiysonge said the Cochrane review is different from other recent reviews because it compares beta-blockers head-to-head against specific antihypertensive medications, rather than comparing beta-blockers against all other high blood pressure medicines as a group.
After combing through 13 studies of 91,561 patients, Wiysonge and colleagues found no difference in the risk of death or cardiovascular disease among those who used beta-blockers, diuretics and RAS inhibitor drugs.
However, the absolute risk of death was a half-percent greater among beta-blocker users compared to those taking calcium channel blockers.
In addition, patients taking beta-blockers had a 1.3 percent increase in the risk of cardiovascular disease — mostly strokes — compared to those taking calcium channel blockers.
Also, “patients who used beta-blockers were more likely to experience undesirable effects and abandon their antihypertension medications” compared to patients who took diuretics or RAS inhibitors, Wiysonge said.
A review of 22 studies published in the medical journal The Lancet in January may suggest another reason to be wary of beta-blockers for high blood pressure. The review concluded that diuretics and beta-blocker treatments may increase the chances of developing type 2 diabetes.
Lancet author Dr. William Elliott of Rush University Medical Center in Chicago said antihypertensive drugs such as ACE inhibitors and angiotensin receptor blockers — types of RAS drugs — were associated with the lowest risk of developing diabetes.
The review was supported by the Medical Research Council, University of Cape Town, University of the Western Cape and University of Stellenbosch, South Africa, and the Ministry of Public Health, Cameroon.
Wiysonge CS, et al. Beta-blockers for hypertension (Review). Cochrane Database of Systematic Reviews 2007, Issue 1.
The Cochrane Collaboration is an international nonprofit, independent organization that produces and disseminates systematic reviews of health care interventions and promotes the search for evidence in the form of clinical trials and other studies of interventions. Visit http://www.cochrane.org for more information.
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