Beta-adrenergic antagonists in hypertension: a review of the evidence.
OBJECTIVE
To evaluate the effects of beta-adrenergic antagonist therapy on cardiovascular and cerebrovascular outcomes in the treatment of hypertension.


METHODS
Literature searches were conducted using MEDLINE (1966-August 2009), International Pharmaceutical Abstracts (1970-August 2009), and Cochrane Database of Systematic Reviews (until third quarter 2009) to locate clinical trials and meta-analyses comparing beta-blocker therapy with placebo or other antihypertensive agents in patients with hypertension. Bibliographies from relevant research and review articles were reviewed for additional references.


METHODS
All English-language articles identified from the data sources were reviewed. Articles describing original research with cardiovascular or cerebrovascular outcomes and/or death as either primary or secondary endpoints were included. Articles describing the use of beta-blocker therapy for conditions other than hypertension were not included.


RESULTS
Five placebo-controlled studies and 10 active-controlled studies were reviewed. In addition, 11 meta-analyses were evaluated. Placebo-controlled trials of beta-blockers in hypertension provide evidence of reduced risk for stroke, cardiovascular events, and heart failure. Only 2 studies comparing beta-blockers with other antihypertensives found significant benefit with beta-blockers. However, the majority of meta-analyses comparing beta-blockers with other antihypertensive agents show increased risk for stroke with beta-blockers, and some data suggest increased risk for cardiovascular events and all-cause mortality. The majority of data results from studies of atenolol, and many studies employed combination antihypertensive therapies, which often included thiazide diuretics.


CONCLUSIONS
Overall, data supporting beta-blockers as preferred therapy in hypertension are inadequate. Although most negative cardiovascular and cerebrovascular outcomes of beta-blockers were associated with atenolol therapy, data supporting other beta-blockers in hypertension are lacking.
Warmack
T Scott
TS
Department of Pharmacy Practice, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
Estes
Mark A
MA
Heldenbrand
Seth
S
Franks
Amy M
AM
D000319:Adrenergic beta-Antagonists / Q000494:pharmacology*; D000959:Antihypertensive Agents / Q000494:pharmacology*; D001262:Atenolol / Q000494:pharmacology; D002318:Cardiovascular Diseases / Q000517:prevention & control; D002561:Cerebrovascular Disorders / Q000517:prevention & control; D002986:Clinical Trials as Topic; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*
D000319:Adrenergic beta-Antagonists; D000959:Antihypertensive Agents; D001262:Atenolol