Beta-blockers increased one-year risks of depression (RR 1.48), anxiety/insomnia (RR 1.53), gastrointestinal side-effects (RR 1.31), and dizziness (RR 1.50) vs CCBs, but not erectile dysfunction.
Do beta-blockers increase the risk of quality-of-life affecting side-effects compared to calcium-channel blockers in patients with hypertension?
In a large nationwide cohort, beta-blockers were associated with an increased risk of depression, anxiety/insomnia, gastrointestinal side-effects, and dizziness/fainting compared to calcium-channel blockers, but surprisingly did not increase the risk of erectile dysfunction.
Absolute Event Rate: 0% vs 0%
Abstract Background Beta-blockers (BBs) are commonly used for a wide range of indications in cardiovascular medicine. Despite a high degree of concern regarding side-effects of BBs, data regarding the incidence of side-effects are inconsistent and real-world evidence is lacking. Purpose To examine absolute and relative risks of potential quality-of-life affecting side-effects associated with BB use. Methods Using Danish nationwide registers, patients with hypertension initiating anti-hypertensive treatment with a BB or a calcium-channel blocker (CCB) as an additional drug in their respective anti-hypertensive regimen between 2012 and 2023 were identified. Standardized one-year risks and adjusted risk ratios of outcomes identified as potential quality-of-life affecting side-effects (depression, anxiety/insomnia, gastrointestinal side-effects, erectile dysfunction, and dizziness/fainting) were computed for patients treated with BBs compared with CCBs. Results A total of 64,722 patients initiating treatment with a BB and 181,880 patients initiating treatment with a CCB. Generally, both sexes were equally represented in the treatment groups, but the BB group was slightly older compared with CCB (median ages of 68 vs 64 years). Comorbidities were also balanced between the groups, however, with a slight overrepresentation of diagnosed kidney disease in the BB group (5% vs 3%). The predominantly prescribed BBs were metoprolol (76%), propranolol (7%), carvedilol (6%), and bisoprolol (6%), whereas amlodipine (84%) and lercanidipine (11%) constituted the majority of the CCB group. In patients initiated on BBs, the standardized one-year risk of any outcome, erectile dysfunction exempt, was 13.7% (95% CI: 13.4%–13.9%). The one-year risk of specific BB side-effects was the highest for anxiety/insomnia (6.2%, 95% CI: 6.0%–6.3%), gastrointestinal side-effects (4.6%, 95% CI: 4.4%–4.7%), and erectile dysfunction (4.7%, 95% CI: 4.5%–4.9%). (Figure 1) The risk of side-effects was almost consistently increased when comparing BB treatment with CCBs including depression (Risk Ratio RR 1.48, 95% CI 1.41–1.55), anxiety/insomnia (RR 1.53, 95% CI 1.47–1.59), gastrointestinal side-effects (1.31, 95% CI 1.25–1.36), and dizziness/fainting (RR 1.50, 95% CI 1.38–1.61). Treatment with BBs did not confer increased risks of erectile dysfunction compared with CCBs in men (RR 0.91, 95% CI, 0.85–0.96). (Figure 1) These findings were substantiated by a dose-response relationship with higher BB dose associated with increased RRs except for erectile dysfunction in which an association was still absent. (Figure 2) Conclusions In a large nationwide cohort, the incidence of BB side-effects was clinically relevant and consistently increased compared with CCBs with the exception of erectile dysfunction. These findings are exceptionally clinically relevant and surprising as erectile dysfunction is often the most prevalent concern for male patients when initiating BB treatment.Figure 1 Figure 2
Holt et al. (Sat,) reported a other. Beta-blockers increased one-year risks of depression (RR 1.48), anxiety/insomnia (RR 1.53), gastrointestinal side-effects (RR 1.31), and dizziness (RR 1.50) vs CCBs, but not erectile dysfunction.