Abstract 2110: Beta-Blockers for Primary Prevention of Heart Failure in Patients with Hypertension: A Meta-Analysis of Randomized Controlled Trials
Background: The evidence to support β-blockers for primary prevention of heart failure in patients with hypertension is unknown.
Methods: We performed a MEDLINE search of Randomized controlled trials (RCTs) which evaluated β-blockers as first line therapy for hypertension with follow-up for at least 1 year.
Results: Among the 12 RCTs which evaluated 112,177 patients with hypertension, the anti-hypertensive efficacy of β-blockers was superior to that of placebo (decrease in BP of 12.6/6.1 mm Hg) which resulted in a trend towards 23% reduction in heart failure risk (P=0.055). When compared to other agents, the anti-hypertensive efficacy of β-blockers was comparable which resulted in no incremental benefit for reduction in heart failure risk for the overall cohort (RR, 1.00; 95% CI, 0.92–1.08), in the elderly (≥ 60 years) or in the young (<60 years). Analysis of secondary outcomes showed that in the elderly, β-blockers were associated with no incremental benefit for the end points of all-cause mortality, cardiovascular mortality or myocardial infarction with a 19% increased risk of stroke when compared to other anti-hypertensive agents (Figure⇓).
Conclusions: In patients with hypertension, primary prevention of heart failure is strongly dependent on blood pressure reduction, such that β-blockers provide a trend towards risk reduction of heart failure when compared to placebo but not when compared to other anti-hypertensive agents where blood pressure reduction was comparable. Given increased risk of stroke in the elderly, they should not be considered as first line agents for primary prevention of heart failure.