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Beta Blockers Poor Choice for Many With Hypertension

Not useful for uncomplicated high blood pressure, new review says

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Updated August 10, 2007

By DrRich

In the August 14, 2007 issue of the Journal of the American College of Cardiology (JACC), a major review looks at the use of beta blockers as primary therapy for uncomplicated hypertension and says "No." ( Read About.com's Guide to High Blood Pressure on complicated vs uncomplicated high blood pressure here. )

Beta blockers are among the most commonly prescribed medications in the United States, and the majority of beta blocker prescriptions are written for high blood pressure. Beta blockers have been shown to improve outcomes and reduce the risk of death in patients who have had heart attacks or heart failure, and their use in these clinical conditions is nearly mandatory. However, despite the fact that beta blockers can reduce blood pressure in many patients, and that they continue to be recommended as effective first-line therapy by U.S. and European guidelines, actual clinical evidence that beta blockers improve outcomes in patients with uncomplicated hypertension has been sparse.

The authors of the review article in JACC looked at several decades of accumulated data, and concluded that there is no credible evidence that beta blockers, when used as single-drug therapy for uncomplicated hypertension, reduces the risk of heart attack, stroke, death, or in any other way improves clinical outcomes. This finding stands in stark contrast to the other antihypertensive agents (such as thiazide diuretics, ACE inhibitors, and calcium channel blockers), which have been shown to significantly improve clinical outcomes.

The authors conclude that, despite current guidelines, patients with uncomplicated hypertension should not receive beta blockers as sole medical treatment.

DrRich comments:

This analysis looks pretty solid. It seems likely that the next version of the U.S. guidelines will drop the recommendation for beta blockers as single drug therapy for uncomplicated hypertension, especially since so many effective alternatives exist.

Readers should take note, however, that beta blockers are still useful in many medical conditions including heart attacks, heart failure, certain cardiac arrhythmias, more complicated forms of hypertension, and even uncomplicated hypertension when single drug therapy proves to be inadequate. If you are taking a beta blocker, there may be a good reason for it. Nobody should stop beta blocker therapy without consulting with their doctor.

Sources:

Bangalore S, Messerli FH, Kostis JB, Pepine CJ. Cardiovascular protection using beta blockers. J Am Coll Cardiol 2007; 50:563-72.

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