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Should β Blockers No Longer Be Considered First-line Therapy for the Treatment of Essential Hypertension Without Comorbidities?
Current Cardiology Reports, 09/13/2011
Clinical Article
Elliott WJ et al. – Although once–daily atenolol as initial antihypertensive therapy may be unwise, whether initial β blockers newer than atenolol reduce cardiovascular risk to the same extent as other antihypertensive drugs should be answered with more clinical trials.
- Although most guidelines committees historically recommended initial diuretics and/or β blockers for uncomplicated hypertension, clinical trial outcomes analyzed in the last 5 to 7 years have been suboptimal with atenolol, the world’s most popular β blocker.
- Several meta–analyses have suggested that despite lowering blood pressure, any and all β blockers inadequately protect hypertensive patients from cardiovascular events.
- These phenomena have been attributed to ineffective lowering of central aortic or inter–visit blood pressures, or adverse metabolic effects (particularly when combined with diuretics).
- Although there has never been a head–to–head comparison of atenolol with any other β blocker in hypertensive patients, indirect comparisons can be done with network and Bayesian meta–analyses, which suggest that heterogeneity of β–blockers’ pharmacology also extends to outcomes.