Hypertension in the elderly: a compelling contraindication for β-blockers?

Bangalore, Sripal; Messerli, Franz H.

doi:10.1038/sj.jhh.1002144

Cited by 7 publications

(5 citation statements)

References 19 publications

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“…Prior studies in patients with hypertension [25][26][27][28][29][30][31][32][33][34] have shown that when compared with placebo, ␤-blocker use is not associated with reduction in all-cause mortality or MI. 35,36 ␤-Blocker use is associated with a 19% to 20% reduction in stroke, 35,36 but this reduction is less than that observed with other antihypertensive agents.…”

Section: ␤-Blocker Use In Patients Without MImentioning

confidence: 99%

β-Blocker Use and Clinical Outcomes in Stable Outpatients With and Without Coronary Artery Disease

Bangalore¹,

Steg²,

Deedwania³

et al. 2012

JAMA

395

237

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Section: ␤-Blocker Use In Patients Without MImentioning

confidence: 99%

β-Blocker Use and Clinical Outcomes in Stable Outpatients With and Without Coronary Artery Disease

Bangalore¹,

Steg²,

Deedwania³

et al. 2012

JAMA

395

237

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show abstract

“…BBs were rated highest. These perceptions or misperceptions are unfortunate and probably occur because physicians extrapolate their cardioprotective effects in HF and myocardial infarction to patients with uncomplicated hypertension (16).…”

Section: Discussionmentioning

confidence: 99%

Beta-Blockers for Primary Prevention of Heart Failure in Patients With Hypertension

Bangalore

Wild

Parkar

et al. 2008

Journal of the American College of Cardiology

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“…Although the twofer certainly is attractive from a pharmacoeconomic point of view, there is no evidence that such an approach is efficacious or safe. We therefore suggest in such a patient to use a betablocker for the compelling indication and to use a drug that has been shown to reduce morbidity and mortality for hypertension (51). Chronic heart failure.…”

Section: Effects On Left Ventricular Hypertrophy (Lvh) Regressionmentioning

confidence: 99%

Cardiovascular Protection Using Beta-Blockers

Bangalore

Messerli

Kostis

et al. 2007

Journal of the American College of Cardiology

216

112

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For more than 3 decades, beta-blockers have been widely used in the treatment of hypertension and are still recommended as first-line agents by national and international guidelines. Recent meta-analyses indicate that, in patients with uncomplicated hypertension, compared with other antihypertensive agents, first-line therapy with beta-blockers was associated with an increased risk of stroke, especially in the elderly cohort with no benefit for the end points of all-cause mortality, cardiovascular morbidity, and mortality. In this review, we critically analyze the evidence supporting the use of beta-blockers in patients with hypertension and evaluate evidence for its role in other indications. The review of the currently available literature shows that in patients with uncomplicated hypertension, there is a paucity of data or absence of evidence to support use of beta-blockers as monotherapy or as first-line agents. Given the increased risk of stroke, their "pseudo-antihypertensive" efficacy (failure to lower central aortic pressure), lack of effect on regression of target end organ effects like left ventricular hypertrophy and endothelial dysfunction, and numerous adverse effects, the risk benefit ratio for beta-blockers is not acceptable for this indication. However, beta-blockers remain very efficacious agents for the treatment of heart failure, certain types of arrhythmia, hypertropic obstructive cardiomyopathy, and in patients with prior myocardial infarction.

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Hypertension in the elderly: a compelling contraindication for β-blockers?

Cited by 7 publications

References 19 publications

β-Blocker Use and Clinical Outcomes in Stable Outpatients With and Without Coronary Artery Disease

β-Blocker Use and Clinical Outcomes in Stable Outpatients With and Without Coronary Artery Disease

Beta-Blockers for Primary Prevention of Heart Failure in Patients With Hypertension

Cardiovascular Protection Using Beta-Blockers

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