title: Should beta blockers remain first choice in the treatment of primary hypertension? A meta-analysis.
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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Public Health and Clinical Medicine, Umeå University Hospital, Umeå, Sweden. Larsh.lindholm@fammed.umu.se
authors.forename: Lars Hjalmar
authors.initials: LH
authors.lastname: Lindholm
authors.forename: Bo
authors.initials: B
authors.lastname: Carlberg
authors.forename: Ola
authors.initials: O
authors.lastname: Samuelsson
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D001262:Atenolol / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D012306:Risk; D020521:Stroke / Q000209:etiology / Q000517:prevention & control
chemical_list: D000319:Adrenergic beta-Antagonists; D001262:Atenolol