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CLINICAL RESEARCH: HEART FAILURE

Beta-Blockers for Primary Prevention of Heart Failure in Patients With Hypertension

Insights From a Meta-Analysis

Department of Medicine, Division of Cardiology, St Luke's Roosevelt Hospital and Columbia University College of Physicians and Surgeons, New York, New York

Manuscript received October 26, 2007; revised manuscript received May 7, 2008, accepted May 13, 2008.

^_* Reprint requests and correspondence: Dr. Franz H. Messerli, Division of Cardiology, St. Luke's-Roosevelt Hospital, Columbia University College of Physicians and Surgeons, 1000 10th Avenue, Suite 3B-30, New York, New York 10019 (Email: messerli.f{at}gmail.com).

Objectives: This study sought to evaluate the efficacy of beta-blockers (BBs) for primary prevention of heart failure (HF) in patients with hypertension.

Background: The American College of Cardiology/American Heart Association staging for HF classifies patients with hypertension as stage A HF, for which BBs are a treatment option. However, the evidence to support this is unknown.

Methods: We conducted a MEDLINE/EMBASE/CENTRAL search of randomized controlled trials that evaluated BB as first-line therapy for hypertension with follow-up for at least 1 year and with data on new-onset HF. The primary outcome was new-onset HF. Secondary outcomes were all-cause mortality, cardiovascular mortality, myocardial infarction, and stroke.

Results: Among the 12 randomized controlled trials, which evaluated 112,177 patients with hypertension, BBs reduced blood pressure by 12.6/6.1 mm Hg when compared with placebo, resulting in a 23% (trend) reduction in HF risk (p = 0.055). When compared with other agents, the antihypertensive efficacy of BBs was comparable, which resulted in similar but no incremental benefit for HF risk reduction in the overall cohort (risk ratio: 1.00; 95% confidence interval: 0.92 to 1.08), in the elderly (60 years) or in the young (<60 years). Analyses of secondary outcomes showed that BBs confirmed similar but no incremental benefit for the outcomes of all-cause mortality, cardiovascular mortality, and myocardial infarction but increased stroke risk by 19% in the elderly.

Conclusions: In hypertensive patients, primary prevention of HF is strongly dependent on blood pressure reduction. When compared with other antihypertensive agents, there was similar but no incremental benefit of BBs for the prevention of HF. However, given the increased risk of stroke in the elderly, BBs should not be considered as first-line agents for prevention of HF.

Key Words: beta-blockers • heart failure • hypertension • meta-analysis

Abbreviations and Acronyms   ACC = American College of Cardiology   ACEI = angiotensin-converting enzyme inhibitor   AHA = American Heart Association   ARB = angiotensin receptor blocker   BB = beta-blocker   CAD = coronary artery disease   CCB = calcium-channel blocker   CI = confidence interval   HF = heart failure   RCT = randomized controlled trial

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