20 Aug Should blockers remain first choice in the treatment of primary hypertension? A meta-analysis
Lars Hjalmar Lindholm, Bo Carlberg, Ola Samuelsson
Background: _ blockers have been used widely in the treatment of hypertension and are recommended as first-line drugs in hypertension guidelines. However, a preliminary analysis has shown that atenolol is not very effective in hypertension. We aim to substantially enlarge the data on atenolol and analyse the effect of different _ blockers.
Methods: The Cochrane Library and PubMed were searched for _ blocker treatment in patients with primary hypertension. Data were then entered into the Cochrane Collaboration Review Manager package and were summarised in meta-analyses. 13 randomised controlled trials (n=105 951) were included in a meta-analysis comparing treatment with _ blockers with other antihypertensive drugs. Seven studies (n=27 433) were included in a comparison of _ blockers and placebo or no treatment.
Findings: The relative risk of stroke was 16% higher for _ blockers (95% CI 4-30%) than for other drugs. There was no difference for myocardial infarction. When the effect of _ blockers was compared with that of placebo or no treatment, the relative risk of stroke was reduced by 19% for all _ blockers (7-29%), about half that expected from previous hypertension trials. There was no difference for myocardial infarction or mortality.
Interpretation: In comparison with other antihypertensive drugs, the effect of _ blockers is less than optimum, with a raised risk of stroke. Hence, we believe that _ blockers should not remain first choice in the treatment of primary hypertension and should not be used as reference drugs in future randomised controlled trials of hypertension.