Beta-blockers should not be first-line for BP
Treatment with beta-blockers is about half as effective at preventing strokes as previous trials have suggested and is less effective than treatment with other, similarly priced, antihypertensive drugs, a meta-analysis published online on 18 October suggests (www.thelancet.com).
The authors argue that beta-blockers should not, therefore, remain as
first choice treatments for primary hypertension and that they should
not be used as reference drugs in trials of hypertension treatments.
Data from 13 randomised controlled trials, including almost 106,000 patients,
were analysed. Treatment with beta-blockers reduced the risk of stroke
by 19 per cent (relative risk 0.81, 95 per cent confidence interval 0.71–0.93),
compared with placebo or no treatment — a figure of 38 per cent,
derived in a previous meta-analysis, is used most frequently in hypertension
guidelines. The
researchers also found that the relative risk
of stroke was 16 per cent higher for beta-blockers than for other drugs.
Thiazide diuretics, angiotensin-converting enzyme inhibitors and calcium
antagonists cost roughly the same as beta-blockers, the authors say. “Hence,
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,” they
conclude. |
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