TY - JOUR
T1 - Beta-blockers in hypertension - the emperor has no clothes: an open letter to present and prospective drafters of new guidelines for the treatment of hypertension
AU - Messerli, FH
AU - Beevers, David
AU - Franklyn, SS
AU - Pickering, TG
PY - 2003/1/1
Y1 - 2003/1/1
N2 - Over the past decade, national and international guidelines have proposed beta-blockers to be used on an equal footing with diuretics for initial therapy of hypertension. This preferred status was supposedly based on evidence documenting a reduction in morbidity and mortality with beta-blocker therapy in hypertension. We systematically analyzed all available outcome studies and found no evidence that beta-blocker based therapy, despite lowering blood pressure, reduced the risk of heart attacks or strokes. Despite the inefficacy of beta-blockers, the incidence of adverse effects is substantial. In the MRC study, for every heart attack or stroke prevented, three patients withdrew from atenolol because of impotence, and another seven withdrew because of fatigue. Thus the risk/benefit ratio of beta-blockers is characterized by lack of efficacy and multiple adverse effects. Given that many thorough, prospective, randomized trials attest to efficacy and safety of diuretics, calcium antagonists, ACE inhibitors, and angiotensin receptor inhibitors, the time has come to admit that beta-blockers should no longer be considered appropriate for first-line therapy in uncomplicated hypertension.
AB - Over the past decade, national and international guidelines have proposed beta-blockers to be used on an equal footing with diuretics for initial therapy of hypertension. This preferred status was supposedly based on evidence documenting a reduction in morbidity and mortality with beta-blocker therapy in hypertension. We systematically analyzed all available outcome studies and found no evidence that beta-blocker based therapy, despite lowering blood pressure, reduced the risk of heart attacks or strokes. Despite the inefficacy of beta-blockers, the incidence of adverse effects is substantial. In the MRC study, for every heart attack or stroke prevented, three patients withdrew from atenolol because of impotence, and another seven withdrew because of fatigue. Thus the risk/benefit ratio of beta-blockers is characterized by lack of efficacy and multiple adverse effects. Given that many thorough, prospective, randomized trials attest to efficacy and safety of diuretics, calcium antagonists, ACE inhibitors, and angiotensin receptor inhibitors, the time has come to admit that beta-blockers should no longer be considered appropriate for first-line therapy in uncomplicated hypertension.
KW - stroke
KW - inefficacy
KW - heart attack
KW - adverse effects
KW - beta-blockers
UR - http://www.scopus.com/inward/record.url?scp=0141786711&partnerID=8YFLogxK
U2 - 10.1016/S0895-7061(03)01017-3
DO - 10.1016/S0895-7061(03)01017-3
M3 - Review article
C2 - 14553968
SN - 1941-7225
VL - 16
SP - 870
EP - 873
JO - American Journal of Hypertension
JF - American Journal of Hypertension
ER -