Are beta-blockers efficacious as first-line therapy for hypertension in the elderly?
The aim of this paper is to assess antihypertensive efficacy of b-blockers and their effects on cardiovascular morbidity and mortality and all-cause mortality in elderly patients with hypertension. Randomized placebo-controlled trials, trials with untreated controls, and trials comparing antihypertensive drugs were selected from the literature. The relative risk reduction of primary endpoints and 95% confidence intervals were calculated. There were six trials in which elderly patients were treated with beta-blockers for hypertension (three trials were placebo-controlled, one trial had untreated controls, and two trials compared antihypertensive drugs). There was no study with monotherapy of beta-blockers. In combination with diuretics, beta-blockers were superior to placebo and untreated controls in preventing cardiovascular events, especially strokes, but there was no superiority of beta-blockers to angiotensin-converting enzyme inhibitors and calcium antagonists in preventing cardiovascular morbidity and mortality and total mortality in elderly patients with hypertension. Beta-blockers are only efficacious in combination with diuretics in preventing cardiovascular morbidity and mortality in elderly patients with hypertension.
Wink
Konrad
K
Medical Faculty University Freiburg, Ordentliches Mitglied der Arzneimittelkommission der Deutschen Arzteschaft, Arzt für Innere Medizin/Kardiologie, Victor-Kretz-Str11, D-77723 Gengenbach, Germany. KWink@t-online.de
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000517:prevention & control; D002986:Clinical Trials as Topic; D004232:Diuretics / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005987:Glyceraldehyde-3-Phosphate Dehydrogenases / Q000627:therapeutic use; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D010446:Peptide Fragments / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D020521:Stroke / Q000517:prevention & control; D016896:Treatment Outcome
D000319:Adrenergic beta-Antagonists; D002121:Calcium Channel Blockers; D004232:Diuretics; D010446:Peptide Fragments; C068142:glyceraldehyde 3-phosphate dehydrogenase (304-313); D005987:Glyceraldehyde-3-Phosphate Dehydrogenases