Primary prevention with beta-blockade in patients with hypertension: review of results and clinical implications.
The MAPHY primary prevention study in hypertensive men aged 40-64 years with diastolic blood pressure above 100 mm Hg showed that total mortality, sudden cardiovascular death, and the pooled incidence of fatal and definite nonfatal coronary events were significantly lower in patients randomized to metoprolol (n = 1,609) than in patients randomized to diuretics (n = 1,625) (p = 0.028, p = 0.017, and p = 0.001, respectively). The publication of the mortality results aroused great interest as well as a number of comments in the literature. The aim of this review is to present comments on the study design, results, and clinical implications of primary preventive studies performed with beta-blockers in hypertension. Statistical analyses of the MAPHY study results convincingly show a substantially lower risk for coronary events in patients on metoprololin relative terms, about a 25% reduction compared with diuretics-with beneficial preventive effects on coronary events both in smokers and nonsmokers. Supporting evidence for the MAPHY study results are available from several other clinical studies in hypertensive men and also from experimental, clinical, and animal studies. The results indicate that the difference in mortality and coronary events in the studies performed probably is mediated via mechanisms other than blood pressure control. Benefits have been attributed to the beta1-blockade of treatment, and evidence suggests that relatively lipophilic beta-blockers are best documented. Cardioselectivity appears to be an advantage for the risk reduction in smokers and also concerning side effects and quality of life. Thus, available data support the choice of a beta-blocker as antihypertensive therapy in patients with increased risk for coronary events unless contraindications limit the choice of these agents. Furthermore, primary prevention and risk reduction in hypertensives is dependent not only on the choice of the antihypertensive agent but also on improved detection and management of the other cardiovascular risk factors.
Wikstrand
J
J
Wallenberg Laboratory for Cardiovascular Research, Sahlgrenska Hospital, Gothenburg University, Sweden.
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D001262:Atenolol / Q000627:therapeutic use; D001581:Benzothiadiazines; D002986:Clinical Trials as Topic / Q000379:methods; D003627:Data Interpretation, Statistical; D004232:Diuretics; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000401:mortality / Q000517:prevention & control; D008790:Metoprolol / Q000627:therapeutic use; D009203:Myocardial Infarction / Q000188:drug therapy / Q000401:mortality / Q000517:prevention & control; D012907:Smoking / Q000401:mortality; D000074606:Smoking Prevention; D049993:Sodium Chloride Symporter Inhibitors / Q000627:therapeutic use*
D000319:Adrenergic beta-Antagonists; D001581:Benzothiadiazines; D004232:Diuretics; D049993:Sodium Chloride Symporter Inhibitors; D001262:Atenolol; D008790:Metoprolol