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Beta-Blockers May Not Be Best for Blood Pressure

New Research Questions Beta-Blockers' Place in High Blood Pressure Treatment

WebMD Health News
Reviewed by Louise Chang, MD

Oct. 18, 2005 -- Beta-blockers may soon lose their place as one of the first line of treatments for high blood pressure, according to a new report.

Beta-blockers have been widely used to treat the nearly 1 billion people worldwide with high blood pressure for the last 30 years. But several recent studies have called the effectiveness of beta-blockers into question.

Primary hypertension, also known as essential hypertension, is high blood pressure without any known cause. It affects around 90% to 95% of those with the diagnosis of high blood pressure. Risk factors that can contribute to this include lifestyle issues such as diet, smoking, and obesity.

The latest blow comes in the form of a review of clinical trials involving more than 100,000 people published in the Oct. 18 issue of The Lancet that shows beta-blockers were no better at reducing the risk of heart attack than other blood pressure drugs and may raise the risk of stroke and death from any cause.

Beta-Blockers on Trial

In the review, Swedish researchers found people with high blood pressure who were treated with beta-blockers in these studies had a 16% higher risk of stroke than those treated with other high blood pressure medications, such as ACE inhibitors, calcium-channel blockers, and diuretics. This difference was significantly shown in the beta-blocker atenolol.

Additionally, there was no difference between the different types of high blood pressure drugs in regard to reducing the risk of heart attack.

The review also showed some evidence that beta-blockers may increase the of risk of stroke and the risk of death from any cause, but these findings were not significant.

In a separate analysis of seven studies that compared beta-blockers with no treatment at all (placebo), researchers found use of beta-blockers reduced the risk of stroke by about 19%, which is about half of the reduction in risk found in previous studies of beta-blockers and stroke.

Based on these results, researchers say beta-blockers should not remain as first choice in the treatment of high blood pressure and should not be used as the comparison drug in future studies of blood pressure-lowering medications.

High Blood Pressure Treatment Guidelines May Change

In an editorial that accompanies the study, D. Gareth Beevers of University Department of Medicine at City Hospital in Birmingham, England, says that there will still be some people who will need beta-blockers as a first line of treatment, but this group should be in the minority.

He says newer drugs in this class may also have other possible benefits and merit further study.

"It will be interesting to see how the many guideline committees respond to the latest information," writes Beevers. "Their current endorsement of beta-blockers must surely be changed. But in the process they may be in danger of 'throwing the baby out with the bathwater.'"

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