title: Beta-blockers are associated with increased risk of first cardiovascular events in non-diabetic hypertensive elderly patients.
abstract: OBJECTIVE
  Although treatment should be considered for elderly patients with hypertension (HTN), the effectiveness of beta-blockers (BBs) compared with other medications is less clear. This study's objective is to assess the relative effectiveness of BBs in elderly primary prevention patients with uncomplicated HTN.
  
  
  METHODS
  This is a population-based nested case-control study. The cohort is composed of 94,844 elderly patients followed through 2009 and diagnosed with HTN between 2000 and 2004, without recent antecedents of diabetes, renal disease, or cardiovascular disease (CVD). Individuals with a CVD outcome were considered cases, and controls were matched to cases according to age, sex, date of cohort entry, and comorbidity index. Patients whose treatment included a BB were compared with patients on other HTN drug(s).
  
  
  RESULTS
  The BB use by patients was associated with an increased risk for CVD events (odds ratio (OR) = 1.36, 95%CI: 1.31-1.40) compared with patients using antihypertensive therapies without BBs. Sensitivity analyses suggest that this increased risk is not due to differences in prescription patterns on the basis of perceived disease severity.
  
  
  CONCLUSIONS
  In real-world settings, antihypertensive therapies that include BBs are associated with less effective prevention of adverse outcomes in elderly hypertensive patients in primary prevention compared with antihypertensive therapies without BBs. Pending further studies, we recommend caution when prescribing BBs in primary prevention except when otherwise indicated.
authors.affiliation: Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, Sherbrooke, Quebec, Canada.
authors.forename: Frederieke M
authors.initials: FM
authors.lastname: Brouwers
authors.forename: Josiane
authors.initials: J
authors.lastname: Courteau
authors.forename: Alan A
authors.initials: AA
authors.lastname: Cohen
authors.forename: Paul
authors.initials: P
authors.lastname: Farand
authors.forename: Lyne
authors.initials: L
authors.lastname: Cloutier
authors.forename: Shabnam
authors.initials: S
authors.lastname: Asghari
authors.forename: Alain
authors.initials: A
authors.lastname: Vanasse
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000009:adverse effects* / Q000627:therapeutic use; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000139:chemically induced; D016022:Case-Control Studies; D015897:Comorbidity; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D008297:Male; D012307:Risk Factors; D012737:Sex Factors
chemical_list: D000319:Adrenergic beta-Antagonists; D000959:Antihypertensive Agents
keywords: beta-blockers; cardiovascular diseases; elderly; hypertension; pharmacoepidemiology; primary prevention