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HYPERTENSION

β-Adrenergic Antagonists in Hypertension: A Review of the Evidence

Associate Professor, Department of Pharmacy Practice, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR

Mark A Estes, PharmD

Assistant Professor, Department of Pharmacy Practice, College of Pharmacy, University of Arkansas for Medical Sciences

Seth Heldenbrand, PharmD

Assistant Professor, Department of Pharmacy Practice, College of Pharmacy, University of Arkansas for Medical Sciences

Amy M Franks, PharmD

Associate Professor, Department of Pharmacy Practice, College of Pharmacy, University of Arkansas for Medical Sciences

Reprints: Dr. Franks, 4301 West Markham St., #522, Little Rock, AR 72205, fax 501/296-1168, afranks{at}uams.edu

OBJECTIVE: To evaluate the effects of β-adrenergic antagonist therapy on cardiovascular and cerebrovascular outcomes in the treatment of hypertension.

DATA SOURCES: Literature searches were conducted using MEDLINE (1966–August 2009), International Pharmaceutical Abstracts (1970–August 2009), and Cochrane Database of Systematic Reviews (until third quarter 2009) to locate clinical trials and meta-analyses comparing β-blocker therapy with placebo or other antihypertensive agents in patients with hypertension. Bibliographies from relevant research and review articles were reviewed for additional references.

STUDY SELECTION AND DATA EXTRACTION: All English-language articles identified from the data sources were reviewed. Articles describing original research with cardiovascular or cerebrovascular outcomes and/or death as either primary or secondary endpoints were included. Articles describing the use of β-blocker therapy for conditions other than hypertension were not included.

DATA SYNTHESIS: Five placebo-controlled studies and 10 active-controlled studies were reviewed. In addition, 11 meta-analyses were evaluated. Placebo-controlled trials of β-blockers in hypertension provide evidence of reduced risk for stroke, cardiovascular events, and heart failure. Only 2 studies comparing β-blockers with other antihypertensives found significant benefit with β-blockers. However, the majority of meta-analyses comparing β-blockers with other antihypertensive agents show increased risk for stroke with β-blockers, and some data suggest increased risk for cardiovascular events and all-cause mortality. The majority of data results from studies of atenolol, and many studies employed combination antihypertensive therapies, which often included thiazide diuretics.

CONCLUSIONS: Overall, data supporting β-blockers as preferred therapy in hypertension are inadequate. Although most negative cardiovascular and cerebrovascular outcomes of β-blockers were associated with atenolol therapy, data supporting other β-blockers in hypertension are lacking.

Key Words: antihypertensive therapy, β-blocker, blood pressure, β-receptor antagonist, hypertension

Published Online, November 24, 2009. www.theannals.com, DOI 10.1345/aph.1M381