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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

Cochrane Library reviews beta-blockers

The Cochrane Library has published a review of beta-blockers for hypertension.

Two recent systematic reviews that found beta-blockers to be less effective than other antihypertensive in reducing strokes, myocardial infarctions and deaths. This review aimed to "quantify the effectiveness and safety of beta-blockers on morbidity and mortality endpoints in adults with hypertension".

Data from thirteen randomised controlled trials including data for over 91,500 patients was analysed. The trials included comparisons of beta-blockers with placebo or active treatments (diuretics, calcium-channel blockers, renin-angiotensin system inhibitors). The review found that beta-blockers tend towards worse outcomes in comparison to other antihypertensives and are only marginally better than placebo or no treatment.

The authors conclude that, "the available evidence does not support the use of beta-blockers as first-line drugs in the treatment of hypertension". This conclusion supports the current National Institute for health and Clinical Excellence Guideline for Hypertension and the position for beta-blockers in the treatment algorithm.

Action: Clinicians should continue to follow the NICE Guideline for Hypertension and reserve beta-blockers for use as a fourth line treatment in resistant cases.

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