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Beta-blockers less protective against stroke, mortality than other antihypertensives

29 Aug 2020

Treatment with beta-blockers confers significantly less protection against stroke and overall mortality compared with other antihypertensive medications, according to a meta-analysis.

“However, [beta-blockers] exhibit a substantial risk-reducing ability for all events when prescribed to lower blood pressure (BP) in patients with modest or more clear BP elevations, and therefore can be used as additional agents in hypertensive patients,” the investigators said.

Randomized trials comparing beta-blockers vs placebo/no-treatment/less-intensive treatment (BP-lowering trials) or beta-blockers vs other antihypertensive agents in patients with or without hypertension (comparison trials) were identified in electronic databases.

The investigators separately considered trials in hypertension, those without chronic heart failure (HF) or acute myocardial infarction (MI), and those with either chronic HF or acute MI among BP-lowering trials and according to baseline comorbidity. They also calculated seven fatal and nonfatal outcomes using random-effects model for BP-lowering or comparison trials.

Eighty-four BP-lowering or comparison trials comprising 165,850 patients met the eligibility criteria. Beta-blockers reduced the incidence of major cardiovascular events (risk ratio [RR], 0.85, 95 percent confidence interval [CI], 0.78–0.92) and all-cause mortality (RR, 0.81, 95 percent CI, 0.75–0.86) in 67 BP-lowering trials (n=68,478; mean follow-up, 2.5 years; baseline systolic BP/diastolic BP, 136/82 mm Hg).

When limiting the analysis to five trials that exclusively enrolled hypertensive patients (n=18,724; mean follow-up, 5.1 years; baseline systolic BP/diastolic BP, 163/94 mm Hg), BP showed a decrease of –10.5/–7.0 mm Hg along with a 22-percent (95 percent CI, 6–34) reduction in major cardiovascular events.

In 24 comparison trials (n=103,764; mean follow-up, 3.92 years), beta blockers appear to be less protective for stroke and all-cause death compared with other agents in all trials and in trials conducted exclusively in hypertensive patients (mean RR increase, 20 percent and 6 percent, respectively, for both cases).

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Most Read Articles
Pearl Toh, 22 Oct 2020
The combination therapy comprising carfilzomib, cyclophosphamide and dexamethasone (KCd) is effective, with a tolerable safety profile, in an Asian cohort with high-risk multiple myeloma (MM) — thus providing a more economical alternative as a potential upfront regimen in resource-limited settings, according to leading experts during a myeloma education webinar.
Roshini Claire Anthony, 13 Nov 2020

Diabetes is a key risk factor for heart failure (HF), which is the leading cause of hospitalization in patients with or without diabetes. SGLT-2* inhibitors (SGLT-2is) have been shown to reduce the risk of hospitalization for HF (HHF) regardless of the presence or absence of diabetes.

Pearl Toh, 5 days ago
Inhaled corticosteroid (ICS) should be the mainstay of long-term asthma management — such is the key message of the latest Singapore ACE* Clinical Guidance (ACG) for asthma, released in October 2020.
Elvira Manzano, 17 Nov 2020
Invasive fungal infections, particularly those caused by Candida species, are common in hospitalized, immunocompromised, or critically ill patients and are associated with considerable morbidity and mortality.