First-line therapy with beta-blockers in uncomplicated hypertension is associated with an increased risk of stroke and no benefit for all-cause mortality compared with other antihypertensive agents.
Do beta-blockers as first-line therapy improve cardiovascular outcomes in patients with uncomplicated hypertension compared to other antihypertensive agents?
This review argues against the use of beta-blockers as first-line therapy for uncomplicated hypertension due to an increased risk of stroke and lack of cardiovascular benefit, challenging some existing guidelines.
For more than 3 decades, beta-blockers have been widely used in the treatment of hypertension and are still recommended as first-line agents by national and international guidelines. Recent meta-analyses indicate that, in patients with uncomplicated hypertension, compared with other antihypertensive agents, first-line therapy with beta-blockers was associated with an increased risk of stroke, especially in the elderly cohort with no benefit for the end points of all-cause mortality, cardiovascular morbidity, and mortality. In this review, we critically analyze the evidence supporting the use of beta-blockers in patients with hypertension and evaluate evidence for its role in other indications. The review of the currently available literature shows that in patients with uncomplicated hypertension, there is a paucity of data or absence of evidence to support use of beta-blockers as monotherapy or as first-line agents. Given the increased risk of stroke, their "pseudo-antihypertensive" efficacy (failure to lower central aortic pressure), lack of effect on regression of target end organ effects like left ventricular hypertrophy and endothelial dysfunction, and numerous adverse effects, the risk benefit ratio for beta-blockers is not acceptable for this indication. However, beta-blockers remain very efficacious agents for the treatment of heart failure, certain types of arrhythmia, hypertropic obstructive cardiomyopathy, and in patients with prior myocardial infarction.
Bangalore et al. (Wed,) conducted a review in Hypertension. Beta-blockers vs. Other antihypertensive agents was evaluated on Stroke, all-cause mortality, cardiovascular morbidity, and mortality. First-line therapy with beta-blockers in uncomplicated hypertension is associated with an increased risk of stroke and no benefit for all-cause mortality compared with other antihypertensive agents.