Beta-blockers increase risk of death in hypertensive patients

Beta-blocker-induced heart rate lowering in hypertensive patients is associated with an increased risk of cardiovascular events and death, results of a systematic review show. Published in the Journal of the American College of Cardiology, the analysis included data from nine randomised trials with over 68,000 hypertensive patients. Overall, 34,096 patients received beta-blockers, 30,139 received other antihypertensive agents, and 3987 received placebo. A lower heart rate was associated with a greater risk for the end points of all-cause mortality (r=-0.51; p<0.0001), cardiovascular mortality (r=-0.61; p<0.0001), MI (r=-0.85; p<0.0001), stroke (r=-0.20; p=0.06), or heart failure (r=-0.64; p<0.0001). The researchers speculate that pharmacologically-induced bradycardia “may lead to dyssynchrony between outgoing and reflected pulse wave, thereby increasing central aortic pressure and the haemodynamic burden to the target organs.” In an editorial accompanying the review, Dr Norman Kaplan (University of Texas, Dallas) said,"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."...