Key result
Beta blockers were associated with a higher risk of the composite endpoint of death, stroke, or myocardial infarction compared to other antihypertensive agents in older adults (RR 1.06).
Why the study?
Do beta blockers improve clinically relevant endpoints such as mortality and cardiovascular events in older adults (≥65 years) with hypertension?
Systematic Review
Do beta blockers improve clinically relevant endpoints such as mortality and cardiovascular events in older adults (≥65 years) with hypertension?
Effect estimate: RR 1.06 (95% CI 1.01-1.10)
Beta blockers are not recommended as first-line therapy for hypertension in older adults due to a lack of mortality benefit and potentially higher risk of cardiovascular events compared to other agents.
Consider alternatives to beta blockers first in older hypertensives; reinforces guidelines against routine first-line use.
BACKGROUND: The benefit from a blood pressure lowering therapy with beta blockers may not outweigh its risks, especially in older populations. The aim of this study was to look for evidence on risks and benefits of beta blockers in older adults and to use this evidence to develop recommendations for the electronic decision support tool of the PRIMA-eDS project. METHODS: Systematic review of the literature using a stage approach with searches for systematic reviews and meta-analyses first, and individual studies only if the previous searches are inconclusive. The target population were older adults (≥65 years old) with hypertension. We included studies reporting on the effectiveness and/or safety of beta blockers on clinically relevant endpoints (e.g. mortality, cardiovascular events, and stroke) in the management of hypertension. The recommendations were developed according to the GRADE methodology. RESULTS: Fifteen studies were included, comprising one meta-analysis, four randomized controlled trials, six secondary analyses of randomized controlled trials and four observational studies. Seven studies involved only older adults and eight studies reported subgroup analyses by age. With regard to a composite endpoint (death, stroke or myocardial infarction) beta blockers were associated with a higher risk of events then were other antihypertensive agents. Further, beta blockers showed no benefit compared to other antihypertensive agents or placebo regarding mortality. They appear to be less effective than other antihypertensive agents in reducing cardiovascular events. Contradictory results were found regarding the effect of beta blockers on stroke. None of the studies explored the effect on quality of life, hospitalisation, functional impairment/status, safety endpoints or renal failure. CONCLUSION: The quality of current evidence to interpret the benefits of beta blockers in hypertension is rather weak. It cannot be recommended to use beta blockers in older adults as first line agent for hypertension.
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Vögele et al. (2017) conducted a systematic review in Hypertension. Beta blockers vs. Placebo or other antihypertensive agents was evaluated on Composite cardiovascular outcome (death, nonfatal myocardial infarction, or nonfatal stroke) vs other antihypertensive agents (RR 1.06, 95% CI 1.01-1.10). Beta blockers were associated with a higher risk of the composite endpoint of death, stroke, or myocardial infarction compared to other antihypertensive agents in older adults (RR 1.06).
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