Beta-blockers & cardiovascular events in hypertensive pa

1 post / 0 new
Beta-blockers & cardiovascular events in hypertensive pa

Bangalore S, Sawhney S, Messerli FH. Relation of Beta-Blocker–Induced Heart Rate Lowering and Cardioprotection in Hypertension. J Am Coll Cardiol 2008 Oct 28;52:1482-1491.


J Am Coll Cardiol, 2008; 52:1482-1489, doi:10.1016/j.jacc.2008.06.048
© 2008 by the American College of Cardiology Foundation

Related Articles
Relation of Beta-Blocker–Induced Heart Rate Lowering and Cardioprotection in Hypertension

Sripal Bangalore, MD, MHA, Sabrina Sawhney, MD and Franz H. Messerli, MD*
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 March 7, 2008; revised manuscript received June 3, 2008, accepted June 6, 2008.
* Reprint requests and correspondence: Dr. Franz H. Messerli, Hypertension Program, 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:


Objectives: The purpose of this study was to evaluate the role of heart rate reduction with beta-blockers on the risk of cardiovascular events in patients with hypertension.
Background: Resting heart rate has been shown to be a risk factor for cardiovascular morbidity and mortality in the general population and in patients with heart disease such as hypertension, myocardial infarction, and heart failure. Conversely, pharmacological reduction of heart rate is beneficial for patients with heart disease. However, the role of pharmacological reduction of heart rate using beta-blockers in preventing cardiovascular events in patients with hypertension is not known.
Methods: We conducted a MEDLINE/EMBASE/CENTRAL database search of studies from 1966 to May 2008. We included randomized controlled trials that evaluated beta-blockers as first-line therapy for hypertension with follow-up for at least 1 year and with data on heart rate. We extracted the baseline characteristics, the blood pressure response, heart rate at the baseline and end of trial, and cardiovascular outcomes from each trial.
Results: Of 22 randomized controlled trials evaluating beta-blockers for hypertension, 9 studies reported heart rate data. The 9 studies evaluated 34,096 patients taking beta-blockers against 30,139 patients taking other antihypertensive agents and 3,987 patients receiving placebo. Paradoxically, a lower heart rate (as attained in the beta-blocker group at study end) was associated with a greater risk for the end points of all-cause mortality (r = –0.51; p Conclusions: In contrast to patients with myocardial infarction and heart failure, beta-blocker–associated reduction in heart rate increased the risk of cardiovascular events and death for hypertensive patients.

Key Words: beta-blockers • heart rate • hypertension
Abbreviations and Acronyms
 CAD = coronary artery disease
 CI = confidence interval
 MI = myocardial infarction
 RCT = randomized controlled trial
 RR = relative risk

Related Articles

Beta-Blockers in Hypertension: Adding Insult to Injury
Norman M. Kaplan
J. Am. Coll. Cardiol. 2008 52: 1490-1491.


Beta-blockers tied to cardiovascular events in hypertensive patients

Last Updated: 2008-10-24 8:00:47 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Beta-blocker-induced heart rate lowering has been shown to have beneficial effects in patients with MI and heart failure, but findings from a new review study indicate that this is not the case in patients with hypertension.

An analysis of data from nine randomized trials, featuring over 68,000 hypertensive patients, shows that heart rate lowering with beta-blockers increases the risks of all-cause death, cardiovascular death, MI, stroke, and heart failure (p

Dr. Franz H. Messerli, from Columbia University in New York, and colleagues speculate that "pharmacologically induced bradycardia may lead to dyssynchrony between outgoing and reflected pulse wave, thereby increasing central aortic pressure and the hemodynamic burden to the target organs."

As reported in the October 28 issue of the Journal of the American College of Cardiology, the investigators searched MEDLINE, EMBASE, and CENTRAL databases for relevant studies released from 1966 to May 2008.

A total of 22 randomized controlled trials were identified, of which 9 included heart rate data. All told, 34,096 patients received beta-blockers, 30,139 received other antihypertensive agents, and 3987 received placebo.

Beta-blocker-treated patients achieved lower heart rates than did other patients and, as noted, this heart rate lowering was linked to adverse cardiovascular events. Moreover, the slower the heart rate, the greater the risk of these events.

In an accompanying editorial, Dr. Norman M. Kaplan, from the University of Texas Southwestern Medical Center in Dallas, comments that the present research "adds another post-mortem explanation for the fall of beta-blockers, showing higher mortality associated with the slower heart rate they induce."
He adds that "with this addition to the evidence, beta-blockers will surely remain as indicated for heart failure, for after MI, and for tachyarrhythmias, but no longer for hypertension in the absence of these compelling indications."

J Am Coll Cardiol 2008;52:1482-1491.

Copyright © 2008 Reuters Limited.