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.
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
Konrad
K
Wink
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