Beta Blockers and Stroke

[OldManEmu]

I found an interesting article the UK medical journal The Lancet concerning the beta blockers and the increased risk of stroke after it was referred to in one of our Australian news papers, unfortunately I am not a subscriber to Lancet so I have only included the portion of the article. I thought this may be of interest given the number of members that are on beta blockers.
http://www.thelancet.com/journals/lancet/issue?volume=366&issue=9496

"Should Β blockers remain first choice in the treatment of primary hypertension? A meta-analysis
Beta blockers are not as effective as other drugs that reduce high blood pressure in patients with hypertension, concludes a meta-analysis. The researchers found that the risk of stroke was 16% higher with beta blockers than with other drugs, while all-cause mortality was 3% higher. However, there was no difference between the drugs in relation to heart problems......"

Do we have any members in the medical profession that can access the whole article?

 

[geebee]

Here's a little more of the article. The full text is only available to paying subscribers. I think the article is saying that beta blockers are less effective than other medications in preventing stroke from high blood pressure, not that beta blockers actually CAUSE strokes. Of course, I could be misinterpreting.

Summary
Background

β blockers have been used widely in the treatment of hypertension and are recommended as first-line drugs in hypertension guidelines. However, a preliminary analysis has shown that atenolol is not very effective in hypertension. We aim to substantially enlarge the data on atenolol and analyse the effect of different β blockers.

Methods

The Cochrane Library and PubMed were searched for β blocker treatment in patients with primary hypertension. Data were then entered into the Cochrane Collaboration Review Manager package and were summarised in meta-analyses. 13 randomised controlled trials (n=105 951) were included in a meta-analysis comparing treatment with β blockers with other antihypertensive drugs. Seven studies (n=27 433) were included in a comparison of β blockers and placebo or no treatment.

Findings

The relative risk of stroke was 16% higher for β blockers (95% CI 4?30%) than for other drugs. There was no difference for myocardial infarction. When the effect of β blockers was compared with that of placebo or no treatment, the relative risk of stroke was reduced by 19% for all β blockers (7?29%), about half that expected from previous hypertension trials. There was no difference for myocardial infarction or mortality.

Interpretation

In comparison with other antihypertensive drugs, the effect of β blockers is less than optimum, with a raised risk of stroke. Hence, we believe that β blockers should not remain first choice in the treatment of primary hypertension and should not be used as reference drugs in future randomised controlled trials of hypertension.

Affiliations

a. Department of Public Health and Clinical Medicine, Umeå University Hospital, Umeå, Sweden
b. Department of Nephrology, Sahlgrenska University Hospital, Göteborg, Sweden

 

[hensylee]

well, that's scary. Lots of us are on beta blockers (I take atenolol 2 x day). I'll have to go ask Dr Rich - or if Barb gets to it first? I'm too busy today. Barb, you listenin?

 

[barbwil]

beta blocker question

beta blocker question

well, that's scary. Lots of us are on beta blockers (I take atenolol 2 x day). I'll have to go ask Dr Rich - or if Barb gets to it first? I'm too busy today. Barb, you listenin?

Ann, saw this about 9 hours after you wrote it but got right on Dr Rich's site (about 4:30 pm) and posed the same question to him. As you know we can't tell when he will see it. Barb

 

[barbwil]

Always a level headed answer

Always a level headed answer

Dr Rich comes through once again!! Here is his reply:

"I would consider this article merely one more salvo in the long, controversial debate over which drug is "best" to use in treating hypertension. There is the diuretic camp, the beta blocker camp, the ACE inhibitor camp, and the combination drug camp. There are large studies to support all lf these posiitons, and large studies to show they are all dangerous in some way, and the debate among hypertension experts is acrimonious. The US government (and, I believe, most other large payers), are strong proponents of the diuretic camp, because these drugs are the cheapest. I can see no distinguishing characteristics about this particular article to make me say, "AHA - here's the anwer at last!" The hypertension literature is and has always been very difficult for me to interpret, and I think of it as I think of the weather - if you don't like what you see, wait a day or two, and it will change."

DrRich (last name is Fogoros)

 

[hensylee]

Thanks, Barb. I knew he'd steer us along the right direction in his own special way. He's really a good guy, isn't he?

I couldn't do it because I had a small surgery and got home late. Had some scar tissue removed from eye - other eye due in two weeks. Hallelujah! A miracle! I can see again!.......... at least in one eye.