Re-examining the efficacy of β-blockers for the treatment of hypertension:: a meta-analysis

Background: In a recently published meta-analysis, investigators asserted that beta-blockers should not be used to treat hypertension. Because the pathophysiology of hypertension differs in older and younger patients, we designed this meta-analysis to clarify the efficacy of beta-blockers in different age groups. The primary outcome was a composite of stroke, myocardial infarction and death. Methods: We identified randomized controlled trials that evaluated the efficacy of beta-blockers as first-line therapy for hypertension in preventing major cardiovascular outcomes. Both authors independently evaluated the eligibility of all trials. Trials enrolling older ( mean age at baseline 3 60 years) patients were separated from those enrolling younger ( mean age < 60 years) patients. Data were pooled using a random effects model. Results: Our analysis incorporated data from 145 811 participants in 21 hypertension trials. In placebo-controlled trials, beta-blockers reduced major cardiovascular outcomes in younger patients ( risk ratio [ RR] 0.86, 95% confidence interval [ CI] 0.74 - 0.99, based on 794 events in 19 414 patients) but not in older patients ( RR 0.89, 95% CI 0.75 - 1.05, based on 1115 events in 8019 patients). In active comparator trials, beta-blockers demonstrated similar efficacy to other antihypertensive agents in younger patients ( 1515 events in 30 412 patients, RR 0.97, 95% CI 0.88 - 1.07) but not in older patients ( 7405 events in 79 775 patients, RR 1.06, 95% CI 1.01 - 1.10), with the excess risk being particularly marked for strokes ( RR 1.18, 95% CI 1.07 - 1.30). Interpretation: beta-blockers should not be considered firstline therapy for older hypertensive patients without another indication for these agents; however, in younger patients beta-blockers are associated with a significant reduction in cardiovascular morbidity and mortality.