Should beta blockers remain first choice in the treatment of primary hypertension? A meta-analysis. Export

@article{citeulike:1386558, abstract = {BACKGROUND: Beta blockers have been used widely in the treatment of hypertension and are recommended as first-line drugs in hypertension guidelines. However, a preliminary analysis has shown that atenolol is not very effective in hypertension. We aim to substantially enlarge the data on atenolol and analyse the effect of different beta blockers. METHODS: The Cochrane Library and PubMed were searched for beta blocker treatment in patients with primary hypertension. Data were then entered into the Cochrane Collaboration Review Manager package and were summarised in meta-analyses. 13 randomised controlled trials (n=105 951) were included in a meta-analysis comparing treatment with beta blockers with other antihypertensive drugs. Seven studies (n=27 433) were included in a comparison of beta blockers and placebo or no treatment. FINDINGS: The relative risk of stroke was 16\% higher for beta blockers (95\% CI 4-30\%) than for other drugs. There was no difference for myocardial infarction. When the effect of beta blockers was compared with that of placebo or no treatment, the relative risk of stroke was reduced by 19\% for all beta blockers (7-29\%), about half that expected from previous hypertension trials. There was no difference for myocardial infarction or mortality. INTERPRETATION: In comparison with other antihypertensive drugs, the effect of beta blockers is less than optimum, with a raised risk of stroke. Hence, we believe that beta blockers should not remain first choice in the treatment of primary hypertension and should not be used as reference drugs in future randomised controlled trials of hypertension.}, address = {Department of Public Health and Clinical Medicine, Ume\r{a} University Hospital, Ume\r{a}, Sweden. Larsh.lindholm@fammed.umu.se}, author = {Lindholm, L. H. and Carlberg, B. and Samuelsson, O.}, citeulike-article-id = {1386558}, citeulike-linkout-0 = {http://dx.doi.org/10.1016/S0140-6736(05)67573-3}, citeulike-linkout-1 = {http://view.ncbi.nlm.nih.gov/pubmed/16257341}, citeulike-linkout-2 = {http://www.hubmed.org/display.cgi?uids=16257341}, doi = {10.1016/S0140-6736(05)67573-3}, issn = {1474-547X}, journal = {Lancet}, keywords = {b\_blockers}, number = {9496}, pages = {1545--1553}, posted-at = {2007-06-13 07:24:25}, priority = {2}, title = {Should beta blockers remain first choice in the treatment of primary hypertension? A meta-analysis.}, url = {http://dx.doi.org/10.1016/S0140-6736(05)67573-3}, volume = {366}, year = {2005} }

TY - JOUR ID - citeulike:1386558 L3 - citeulike-article-id:1386558 N2 - BACKGROUND: Beta blockers have been used widely in the treatment of hypertension and are recommended as first-line drugs in hypertension guidelines. However, a preliminary analysis has shown that atenolol is not very effective in hypertension. We aim to substantially enlarge the data on atenolol and analyse the effect of different beta blockers. METHODS: The Cochrane Library and PubMed were searched for beta blocker treatment in patients with primary hypertension. Data were then entered into the Cochrane Collaboration Review Manager package and were summarised in meta-analyses. 13 randomised controlled trials (n=105 951) were included in a meta-analysis comparing treatment with beta blockers with other antihypertensive drugs. Seven studies (n=27 433) were included in a comparison of beta blockers and placebo or no treatment. FINDINGS: The relative risk of stroke was 16% higher for beta blockers (95% CI 4-30%) than for other drugs. There was no difference for myocardial infarction. When the effect of beta blockers was compared with that of placebo or no treatment, the relative risk of stroke was reduced by 19% for all beta blockers (7-29%), about half that expected from previous hypertension trials. There was no difference for myocardial infarction or mortality. INTERPRETATION: In comparison with other antihypertensive drugs, the effect of beta blockers is less than optimum, with a raised risk of stroke. Hence, we believe that beta blockers should not remain first choice in the treatment of primary hypertension and should not be used as reference drugs in future randomised controlled trials of hypertension. IS - 9496 JF - Lancet SN - 1474-547X AD - Department of Public Health and Clinical Medicine, Umeå University Hospital, Umeå, Sweden. Larsh.lindholm@fammed.umu.se EP - 1553 TI - Should beta blockers remain first choice in the treatment of primary hypertension? A meta-analysis. VL - 366 SP - 1545 KW - b_blockers AU - Lindholm, LH AU - Carlberg, B AU - Samuelsson, O PY - 2005///4 UR - http://dx.doi.org/10.1016/S0140-6736(05)67573-3 ER -