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From the Division of General Internal Medicine, University of British Columbia (Khan),Vancouver, BC, and the Division of General Internal Medicine, University of Alberta (McAlister), Edmonton, Alta.
Correspondence to: Dr. Finlay McAlister, 2E3.24 Walter Mackenzie Health Sciences Centre, University of Alberta Hospital, 8440 112 St., Edmonton AB T6G 2R7
Abstract
Background: In a recently published meta-analysis, investigators asserted that ß-blockers should not be used to treat hypertension. Because the pathophysiology of hypertension differs in older and younger patients, we designed this meta-analysis to clarify the efficacy of ß-blockers in different age groups. The primary outcome was a composite of stroke, myocardial infarction and death.
Methods: We identified randomized controlled trials that evaluated the efficacy of ß-blockers as first-line therapy for hypertension in preventing major cardiovascular outcomes. Both authors independently evaluated the eligibility of all trials. Trials enrolling older (mean age at baseline 
60 years) patients were separated from those enrolling younger (mean age < 60 years) patients. Data were pooled using a random effects model.
Results: Our analysis incorporated data from 145 811 participants in 21 hypertension trials. In placebo-controlled trials, ß-blockers reduced major cardiovascular outcomes in younger patients (risk ratio [RR] 0.86, 95% confidence interval [CI] 0.74–0.99, based on 794 events in 19 414 patients) but not in older patients (RR 0.89, 95% CI 0.75–1.05, based on 1115 events in 8019 patients). In active comparator trials, ß-blockers demonstrated similar efficacy to other antihypertensive agents in younger patients (1515 events in 30 412 patients, RR 0.97, 95% CI 0.88–1.07) but not in older patients (7405 events in 79 775 patients, RR 1.06, 95% CI 1.01–1.10), with the excess risk being particularly marked for strokes (RR 1.18, 95% CI 1.07–1.30).
Interpretation: ß-blockers should not be considered first-line therapy for older hypertensive patients without another indication for these agents; however, in younger patients ß-blockers are associated with a significant reduction in cardiovascular morbidity and mortality.
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