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Beta Blockers for Hypertension, Heart Failure Prevention May Raise Stroke Risk: Presented at AHA

By Carole Bullock

ORLANDO, FL -- November 7, 2007 -- Beta blockers as first-line hypertensive therapy for heart failure prevention did not provide stroke protection in a meta-analysis, investigators reported here at the American Heart Association (AHA) 2007 Scientific Sessions.

Beta blockers may not offer the same protection from stroke as other antihypertensive agents -- a key clinical goal that may help reduce heart failure risk, reported researcher Sripal Bangalore, MD, Cardiology Fellow, St. Luke's Roosevelt Hospital, New York, New York, and colleagues.

"Beta blockers are considered a cornerstone for treatment of established heart failure, but when used in hypertension, there was a 19% stroke risk increase, with no additional advantage over other antihypertensive agents for primary prevention of heart failure," he said.

The aim of the study was to determine whether beta blockers would benefit hypertensive patients as a primary prevention strategy for heart failure.

A MEDLINE search of randomized controlled trials which evaluated the drugs as primary prevention for hypertension included 112,177 hypertensive patients from 12 studies that tested the antihypertensive efficacy of beta blockers.

Six of the 12 trials included patients older than 60 years. Relative risks for the four endpoints were: 1.03 (P =.146) for death; 1.05 (P =.145) for cardiovascular death; 1.03 (P =.459) for myocardial infarction (MI); 1.19 (P <=.00001) for stroke.

Beta blockers resulted in a trend (P =.055) towards 23% reduction in heart failure risk, but only when compared with placebo, and not when compared with other antihypertensives, according to the study.

"The apparent antihypertensive efficacy of beta blockers was comparable to other agents, and resulted in no incremental benefit for reduction in heart failure risk for the overall cohort," Dr. Bangalore reported. "However, the increased stroke risk may be related to the pseudoantihypertensive effect of traditional beta blockers -- failure to lower central aortic pressure when compared to other antihypertensives."

"This increase does not justify use of beta blockers for primary heart failure prevention in hypertension," stressed senior author of the study, Franz H Messerli, MD, St. Luke's Roosevelt Hospital, New York, New York.

"In previous studies, these agents have been shown to elevate stroke risk in patients with hypertension, but given such a superb track record for treating heart failure, it was not questioned whether these medications would also be useful in preventing heart failure," Dr. Bangalore said. "Given increased risk of stroke in the elderly, I would not recommend beta blockers for heart failure prevention in patients with uncomplicated hypertension, unless the patient had a comorbidities mandating beta blockade, such as unstable angina or prior MI."

He also cautioned that this is a meta-analysis with limitations, since dosing was not controlled and the drugs (atenolol and metoprolol) used in the analysis tended to be older agents. "There might be different effects from the newer vasodilating beta blockers, such as carvedilol and nebivolol," Dr. Messerli said.

Dr. Messerli admits the topic is expected to stir controversy among researchers and clinicians.

"Prevention of stroke and heart failure in our hypertensive patients is a critical goal, and we should be sure that our choices in therapy provide good blood pressure control, but also protection from those events," said Ann Bolger, MD, Professor of Medicine at the University of California at San Francisco, San Francisco, California, and spokesperson for the AHA. "Recent data that emphasize the different effects on central aortic pressure from different common drugs is what makes this study very intriguing."


[Presentation title: BETAeta-Blockers for Primary Prevention of Heart Failure in Patients with Hypertension: A Meta-Analysis of Randomized Controlled Trials. Abstract 2110]

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