Thumbs Down on Beta Blockers for High Blood Pressure

Sept. 16 -- MONDAY, Sept. 15 (HealthDay News) -- Beta blocker drugs don't prevent development of heart failure in people with high blood pressure and should not be used as first-line treatment for the condition, an analysis of studies indicates.

"For heart failure, beta blockers clearly are an integral therapy," said Dr. Marrick Kukin, a professor of clinical medicine at Columbia University's College of Physicians and Surgeons, and a member of the team reporting the results in the Sept. 16 issue of the Journal of the American College of Cardiology. "But it has never been proven that they have a role for hypertension in preventing heart failure," Kukin said.

Hypertension is the medical term for high blood pressure. One major goal in treating hypertension is to prevent heart failure, the progressive loss of the heart's ability to pump blood, which can be fatal. Kukin was one of a group led by Dr. Franz H. Messerli, a Columbia cardiologist, that analyzed the results of 12 controlled trials in which 112,177 people were treated for high blood pressure.

"Our meta-analysis showed that compared to placebo, beta blockers offered a benefit," Kukin said. "But when compared to other medications, such as ACE inhibitors, there was no difference. Also, there was an increased risk of stroke with beta blockers in older patients, which has been shown in other trials."

The risk of stroke in elderly people was increased by 19 percent in those taking beta blockers.

Beta blockers help the heart by limiting the effect of adrenaline. Diuretics lower blood pressure by draining fluid from the body, while ACE inhibitors block production of an enzyme that constricts blood vessels.

This is one of a series of studies that have cast doubt on the use of beta blockers as the first line of treatment of high blood pressure. Studies done in Europe led British authorities to issue guidelines recommending against use of beta blockers as first-line hypertension therapy two years ago.

But Kukin, who described himself as "the heart failure person" in the group that produced the report, said that beta blockers "unequivocally are part of the therapy for someone with heart failure." They also are essential in treatment of heart attacks, he said. The new report simply emphasizes that they have no benefit over other blood pressure medications but do carry the extra risk of stroke, he said.

Another report in the same issue of the journal is the latest to describe an advantage of drug-coated stents over the bare-metal kind inserted to keep arteries open. Physicians at the Cleveland Clinic compared 6,053 patients who received drug-coated stents with 1,983 who were given bare-metal stents.

The death rate from all causes was about a third lower in the coated stent group, the report said. Adjustments for other accompanying conditions such as anemia, depression and socioeconomic status found the death rate for the coated stent group was almost 50 percent lower than for the bare-metal stent recipients.

More information

Learn about high blood pressure and its treatment from the U.S. National Library of Medicine.

SOURCES: Marrick Kukin, professor, clinical medicine, Columbia University College of Physicians and Surgeons, New York City; Sept. 16, 2008, Journal of the American College of Cardiology