title: A meta-analysis of randomized controlled trials assessing the impact of beta-blockers on arterial stiffness, peripheral blood pressure and heart rate.
abstract: BACKGROUND
  The recognition of beta-blockers as a preferred initial therapy for hypertension has been a hot topic of debate recently. This meta-analysis was aimed to assess the impact of different beta-blockers on arterial stiffness as indexed by pulse wave velocity (PWV), peripheral blood pressure (BP) and heart rate, relative to the placebo, angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs).
  
  
  METHODS
  Two authors independently searched articles, appraised eligibility and abstracted information, and the data were analyzed using STATA.
  
  
  RESULTS
  Twenty-four articles involving 27 independent trials were eligible. Relative to the placebo, treatment with beta-blockers led to remarkable improvement in PWV (WMD, 95% CI, P: -1.115m/s, -1.561 to -0.669, <0.001), systolic BP (-12.355mmHg, -14.330 to -10.380, <0.001), diastolic BP (-8.619mmHg, -10.357 to -6.880, <0.001), mean BP (-9.683mmHg, -11.172 to -8.194, <0.001), pulse pressure (-4.448mmHg, -7.386 to -1.510, 0.003) and heart rate (-12.335, -22.739 to -1.932, 0.020). Beta-blockers were remarkably superior to ACEIs in DBP (-2.540mmHg, -4.463 to -0.617, 0.010) and heart rate (-9.859bpm, -11.752 to -7.969, <0.001). In contrast to ARBs, beta-blocker treatment increased systolic BP (2.042mmHg, 0.639 to 3.444, 0.004) but reduced heart rate (-8.814bpm, -9.756 to -7.873, <0.001) significantly. No publication bias was observed.
  
  
  CONCLUSIONS
  Beta-blockers exerted more favorable impact than the placebo on arterial stiffness, peripheral BP and heart rate, but less favorable impact than ACEIs or ARBs on all, except heart rate, characters, especially in trials with longer duration of treatment and higher baseline PWV.
authors.affiliation: State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. Electronic address: niuwenquan_shcn@163.com.
authors.forename: Wenquan
authors.initials: W
authors.lastname: Niu
authors.affiliation: Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China.
authors.forename: Yue
authors.initials: Y
authors.lastname: Qi
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000494:pharmacology / Q000627:therapeutic use*; D047228:Angiotensin II Type 1 Receptor Blockers / Q000494:pharmacology / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000494:pharmacology / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000494:pharmacology / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects* / Q000502:physiology; D006339:Heart Rate / Q000187:drug effects* / Q000502:physiology; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology; D016032:Randomized Controlled Trials as Topic / Q000379:methods*; D059289:Vascular Stiffness / Q000187:drug effects* / Q000502:physiology
chemical_list: D000319:Adrenergic beta-Antagonists; D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents
keywords: Angiotensin converting enzyme inhibitor; Angiotensin receptor blocker; Arterial stiffness; Beta-blocker; Meta-analysis; Pulse wave velocity