Are beta-blockers a suitable first-line treatment for hypertension?

This study examined the effect of beta-blockers on arterial stiffness, blood pressure, and heart rate in patients with hypertension. The authors concluded that beta blockers are more effective than a placebo (control substance with no active effect) at reducing these risk factors. However, beta blockers were overall less effective than current first-line treatments.

Patients with hypertension have a higher resting blood pressure than the body needs. Patients with hypertension often experience complications such as heart attacks, increased heart rate, and arterial stiffness. The stiffness of arteries influences how hard the heart has to work to pump blood through the body. This can be measured by pulse wave velocity (PWV).

Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are commonly prescribed treatments for hypertension. These drugs work by relaxing the blood vessels and lowering blood pressure. Beta-blockers are another type of treatment. These reduce blood pressure by blocking the activity of a hormone that usually makes the heart work harder. Beta-blockers are not commonly prescribed as a first-line treatment. More evidence is needed examining their effectiveness.

The authors analyzed 27 different trials involving 2,289 hypertensive patients to compare the effect of beta blockers to treatments with placebo, ACEIs and ARBs. Blood pressure, heart rate, and arterial stiffness were all measured. Patients were followed for an average of 4 weeks to 12 months.

Reductions were seen in all measurements in patients treated with beta-blockers compared to placebo-treated patients. Arterial stiffness (measured by PWV) decreased by 1.12 m/s, systolic blood pressure (SBP – pressure when the heart is contracting) decreased by 12.36 mm Hg. Diastolic blood pressure (DBP – pressure when the heart is between beats) decreased by 8.62 mm Hg. A reduction of 9.68 mm Hg in mean blood pressure and 4.45 mm Hg in pulse pressure was also seen. Heart rate decreased by 9.86 bpm.

Beta blockers decreased DBP and heart rate compared to ACEIs, but increased SBP compared to ARBs.

Authors concluded that beta blockers are more effective than placebo at reducing heart rate, blood pressure, and arterial stiffness than placebo. However, beta blockers were overall less effective when compared to ACEIs and ARBs.

This data was generated by combining data from 27 different studies. Drug dosages and treatment times varied across all studies.