Should β blockers remain first choice in the treatment of primary hypertension?: A meta-analysis
Should β blockers remain first choice in the treatment of primary hypertension?: A meta-analysis
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DOI：
10.1016/s0140-6736(05)67573-3
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发表时间：
2005-10-01
期刊：
影响因子：
168.9
通讯作者：
Samuelsson, O
中科院分区：
文献类型：
--
作者：
Lindholm, LH;Carlberg, B;Samuelsson, O
背景：β受体阻滞剂已广泛用于高血压的治疗，并被高血压指南推荐为一线药物。然而，初步分析表明，阿替洛尔对高血压不是很有效。我们的目的是大幅扩大阿替洛尔的数据和分析不同的β受体阻滞剂的效果。方法：检索科克伦图书馆和PubMed的β受体阻滞剂治疗原发性高血压患者。然后将数据输入科克伦协作审查管理器包，并在荟萃分析中进行总结。13项随机对照试验（n=105 951）被纳入一项比较β受体阻滞剂与其他降压药物治疗的荟萃分析。7项研究（n=27 433）被纳入β受体阻滞剂和安慰剂或无treatment.Findings的比较：中风的相对风险为16%，β受体阻滞剂（95%CI 4-30%）比其他药物高。心肌梗死无差异。当β受体阻滞剂的效果与安慰剂或不治疗相比时，所有β受体阻滞剂的中风相对风险降低了19%（7-29%），约为先前高血压试验预期的一半。心肌梗死或死亡率没有差异。解释：与其他降压药相比，β受体阻滞剂的效果低于最佳，中风的风险增加。因此，我们认为β受体阻滞剂不应作为原发性高血压治疗的首选药物，也不应作为未来高血压随机对照试验的参考药物。
Background: beta 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 beta blockers.Methods: The Cochrane Library and PubMed were searched for beta 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 beta blockers with other antihypertensive drugs. Seven studies (n=27 433) were included in a comparison of beta blockers and placebo or no treatment.Findings: The relative risk of stroke was 16% higher for beta blockers (95% CI 4-30%) than for other drugs. There was no difference for myocardial infarction. When the effect of beta blockers was compared with that of placebo or no treatment, the relative risk of stroke was reduced by 19% for all beta 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 beta blockers is less than optimum, with a raised risk of stroke. Hence, we believe that beta 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.