NEW YORK (Reuters Health) – Beta-adrenergic receptor antagonists are no more effective than other medications used for primary prevention of heart failure in patients with hypertension, according to physicians at Columbia University College of Physicians and Surgeons.

Based on results of their meta-analysis in which they also found that beta blockers increase the risk of stroke in the elderly, senior author Dr. Franz H. Messerli and co-investigators advise that “beta blockers should not be used in the primary prevention of heart failure, unless compelling circumstances such as prior myocardial infarction were already present.”

To evaluate the efficacy of beta blockers for preventing progression to overt heart failure, the New York-based research team conducted a meta-analysis of 12 randomized controlled trials involving 112,177 patients with hypertension.

Pooled analysis also showed that beta blockers reduced the risk of heart failure by about 23% (p = 0.055). The results were comparable to those achieved by angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, diuretics, and calcium-channel blockers.

However, beta blockers provided “no incremental benefit for the outcomes of all-cause mortality, cardiovascular mortality, and myocardial infarction, but increased stroke risk by 19% in the elderly.”

Until more data are in, the author of a related editorial agrees that monotherapy with beta-blockers should not be routinely used as first-line therapy to treat hypertension.

Nevertheless, Dr. Michael B. Fowler at Stanford University in California emphasizes that combination treatment is more the norm than single-drug therapy for hypertension.

“Only one half of patients with hypertension are adequately treated,” he states. “The tendency to demonize one class of drugs, especially a drug class with profound benefits to patients with established cardiac disease, can only contribute to further therapeutic nihilism.”

He adds that differences between individual drug classes “are of trivial consequence compared with the adverse impact of inadequate treatment.”

Reference:
J Am Coll Cardiol 2008;52:1062-1075.