title: The impact of beta-blockers on mortality in stable angina: a meta-analysis.
abstract: Beta-blockers are recommended as first-line symptomatic treatment for stable angina. However, their impact on mortality outside the context of myocardial infarction is unknown. We performed a meta-analysis of all randomized trials of beta-blockers in stable angina. Medical databases and cardiology journals were searched for relevant randomized clinical trials. The primary outcome was cardiovascular mortality, separately considering trials of beta-blockers versus placebo and beta-blockers versus other antianginals. We conducted a subgroup analysis on cardioselective versus non-cardioselective beta-blockers and calcium channel antagonists versus nitrates. We calculated odds ratios (ORs) and confidence intervals (CIs) using Peto's method. We found no statistically significant evidence that beta-blockers impact on mortality when compared with placebo (OR, 0.42; CI , 0.15-1.21) or other antianginals (OR, 0.98; CI, 0.86-1.10), or all others (OR, 0.97; CI, 0.86-1.09). There was a trend for cardioselective beta-blockers to have a greater improvement in mortality when compared with placebo and to have greater impact than non-calcium channel antagonists. Beta-blockers do not have statistically significant impact on mortality versus placebo or versus other active comparators. The findings exclude a benefit of 15% or greater and a hazard of 10% or greater. The impact of cardioselectivity requires further study.
authors.affiliation: University of Edinburgh, Edinburgh,  Scotland, UK.
authors.forename: H L
authors.initials: HL
authors.lastname: Huang
authors.forename: K A A
authors.initials: KA
authors.lastname: Fox
mesh_terms: D060050:Angina, Stable / Q000188:drug therapy* / Q000401:mortality; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000494:pharmacology*; D002121:Calcium Channel Blockers / Q000008:administration & dosage / Q000494:pharmacology*; D005260:Female; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000188:drug therapy / Q000401:mortality / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic
chemical_list: D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers