The use of beta-blockers in the treatment of hypertension

This large meta-analysis (an analysis combining data from several similar studies) reviewed the effects of beta-blocker therapy as an initial choice in the treatment of hypertension.

Beta-blockers (such as neobloc, zebeta and lopressor) are commonly prescribed for hypertension. Beta-blockers reduce blood pressure by blocking the effects of a hormone called adrenaline on the heart. This reduces the intensity of heartbeats, and thereby blood pressure. Beta-blockers also reduce the production of a hormone called aldosterone which normally elevates blood pressure by accumulating salt and water in the blood. 

Other drugs, with other mechanisms of action, are also commonly used in the treatment of hypertension, in addition to, or instead of, beta-blockers. These include calcium channel blockers (CCBs), ACE inhibitors and diuretics. CCBs (such as amlow, vasodip and norvasc), relax blood vessels by affecting the muscle cells in the arterial walls. ACE inhibitors (such as captopril, altace and diovan) reduce blood pressure by inhibiting the effect of a hormone called angiotensin II, which constricts blood vessels and increase blood volume via aldosterone. Diuretics (such as fusid, lasix and chlorothiazide) reduce blood pressure by causing the body to produce more urine, and to urinate more often.

This analysis included 13 studies comparing beta-blockers to placebo (a substance with no therapeutic effect), CCBs, ACE inhibitors or diuretics, as the first-line anti-hypertensive drug (first treatment given). In most atenolol (Tenormin) was the beta blocker of choice. They found that the use of beta-blockers did not significantly reduce the risk of death compared to a placebo, ACE inhibitors or diuretics. However, it was 7% higher for beta-blocker users compared to patients using CCBs.

The risk of developing cardiovascular diseases (CVDs) was significantly lower for beta-blockers compared to placebo; did not differ from ACE inhibitors or diuretics; but was higher than CCBs. However, this protective effect was related mostly to stroke prevention, not heart disease. 

Patients taking beta-blockers were more likely to stop treatment due to side events compared to those on ACE inhibitors (but not relatively to those on CCBs).

This study concluded that beta-blockers are not recommended as first choice treatment for hypertension, and do not lead to a significant reduction in mortality. Beta-blockers seem to be less effective than other blood pressure lowering drugs in preventing death, strokes and heart attacks.

This study did not take into account the effect of different types of beta-blockers. In addition, many of the studies reviewed in this analysis were considered to have a low grade of evidence, meaning that their published results are not considered statistically sound.

Consult with your physician about the different drugs available for the treatment of hypertension.