Newly Diagnosed With High Blood Pressure? You might want to skip the beta blocker By Paual Rasich Reviewed by Elizabeth Klodas, MD, FACC October 20, 2008--If you’ve been diagnosed with hypertension, and need a drug to control your high blood pressure, there’s an array of medications to pick from. However, the group of drugs called beta blockers (that work by slowing the heart rate) may not be the best first treatment choice for some.

Though beta blocker therapy has been shown to extend life in heart attack victims and those living with heart failure, the lower heart rates seen in some patients who receive beta blockers for treatment of high blood pressure appear to be associated with an increased risk of heart attack, stroke and death.  That was the finding of a recent combined review of nine large blood pressure treatment trials.

In the analysis, involving nearly 65,000 patients with high blood pressure, half got beta blockers and nearly half took other blood pressure medications; a small number received placebo pills. From day one to the time the studies ended, heart rate (the number of beats per minute) and blood pressure readings were recorded. The average study duration was one year.

When researchers from Columbia University College of Physicians and Surgeons in New York City analyzed the data, they discovered that the slower heart rate achieved by the beta-blocker-treated group correlated with an increased risk of death (51%), heart attack (85%), stroke (20%), and heart failure (64%), compared with the other groups.

“This research adds to the growing evidence that for the treatment of hypertension, beta blockers are not any more beneficial than other drugs and that they do, in fact, increase the likelihood of untoward cardiovascular events,” stated Norman M. Kaplan, MD, clinical professor of internal medicine at the University of Texas Southwestern Medical Center in Dallas.

Not all physicians agree with the conclusions of the study.  “The study only shows an inverse relationship between heart rate at the end of the study and cardiovasuclar events, but these results may be due to confounding factors outside of medication choice that the current study was not geared to analyze” states Robert A. Phillips, MD, Professor of Medicine & Clinical/Population Health Research at UMass Medical and Graduate School of Biomedical Sciences.  “And it is not known whether the patients that achieved lower heart rates in the study did so because they simply had blood pressures which were harder to control and required higher medication doses.  In other words, it was the severity of blood pressure abnormalities, rather than the heart rate result, which resulted in outcome differences.”

Talk with your doctor about finding the right therapy customized to your condition.  Patients with other heart problems in addition to hypertension may gain significant benefit from beta blocker therapy and should stay on these medications.  And beta blockers should not be stopped abruptly as this may cause sudden dangerous increases in heart rate or blood pressure.

“There are a lot of people using beta blockers; we don’t recommend that people stop, but that they confer with their physician to see if other types of medication might be preferable,” says Dr. Kaplan.

Other common medications used to bring blood pressure down include diuretics, ACE inhibitors and calcium channel blockers.

This study and editorial comment are published in the October 28 issue of the Journal of the American College of Cardiology.

Sources:

Bangalore S et al. Relation of Beta-Blocker—Induced Heart Rate Lowering and Cardioprotection in Hypertension. Journal of the American College of Cardiology, 2008.

Kaplan NM. Editorial Comment: Beta-Blockers in Hypertension: Adding Insult to Injury.  Journal of the American College of Cardiology, 2008.

Norman Kaplan, MD, Clinical Professor of Internal Medicine at the University of Texas Southwestern Medical Center, Dallas, Texas.

Robert A. Phillips, MD, Professor of Medicine & Clinical/Population Health Research at UMass Medical and Graduate School of Biomedical Sciences, Worcester, Massachusetts.