- Prescribing Advice for GPs - https://www.prescriber.org.uk -

Systematic Review of Beta-blocker Benefit

The Lancet has published a systematic review of Beta Blockers in Hypertension. The title of the review is "Should β blockers remain first choice in the treatment of primary hypertension? A meta-analysis". The review has been picked up already by the Daily Mail and the newspapers article is available online.

The review consisted of two parts. Firstly, a review of 7 placebo controlled trials totalling about 27,500 patients. Secondly, a review of 13 active comparator trials totalling about 160,000 patients. The review looked at strokes, myocardial infarction and all cause mortality as endpoints. It should be noted that all figures quoted below are relative risk reductions (RRRs). Actual risk reductions (ARRs) or calculated numbers needed to treat (NNTs) would be more helpful in clarifying the full impact of the differences.

In comparison to placebo, Beta Blockers reduced the relative risk of stroke by 19%. No benefit was shown overall on myocardial infarctions or all cause mortality.

In comparison to active treatments, it was found that the 'newer' drugs reduced the relative risk of stroke by 16%. There were no differences in relation to myocardial infarctions or all cause mortality.

The Lancet article questions the place of Beta Blockers as a first line treatment for Hypertension. The NICE Guideline for Hypertension places Thiazides as first line anti-hypertensives. These guidelines do not place Beta Blockers as first line. The Daily Mail article puts spin on the numbers by down playing the stroke risk reduction of beta blockers compared to placebo and up playing the benefits of the 'newer' drugs.

Action: Prescribers should continue to follow the NICE Guideline for Hypertension. Patients on mono-therapy with Beta Blockers who have stable and controlled blood pressure should be re-assured about the efficacy of the medication. Patients who are newly diagnosed or who are not at optimal blood pressure should be managed as per the NICE Guideline.