Document Detail

beta-Blockers in hypertension-the emperor has no clothes: an open letter to present and prospective drafters of new guidelines for the treatment of hypertension.
MedLine Citation:
PMID:  14553968     Owner:  NLM     Status:  MEDLINE    
Over the past decade, national and international guidelines have proposed beta-blockers to be used on an equal footing with diuretics for initial therapy of hypertension. This preferred status was supposedly based on evidence documenting a reduction in morbidity and mortality with beta-blocker therapy in hypertension. We systematically analyzed all available outcome studies and found no evidence that beta-blocker based therapy, despite lowering blood pressure, reduced the risk of heart attacks or strokes. Despite the inefficacy of beta-blockers, the incidence of adverse effects is substantial. In the MRC study, for every heart attack or stroke prevented, three patients withdrew from atenolol because of impotence, and another seven withdrew because of fatigue. Thus the risk/benefit ratio of beta-blockers is characterized by lack of efficacy and multiple adverse effects. Given that many thorough, prospective, randomized trials attest to efficacy and safety of diuretics, calcium antagonists, ACE inhibitors, and angiotensin receptor inhibitors, the time has come to admit that beta-blockers should no longer be considered appropriate for first-line therapy in uncomplicated hypertension.
Franz H Messerli; D Gareth Beevers; Stanley S Franklin; Thomas G Pickering
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  American journal of hypertension     Volume:  16     ISSN:  0895-7061     ISO Abbreviation:  Am. J. Hypertens.     Publication Date:  2003 Oct 
Date Detail:
Created Date:  2003-10-13     Completed Date:  2004-02-26     Revised Date:  2009-02-24    
Medline Journal Info:
Nlm Unique ID:  8803676     Medline TA:  Am J Hypertens     Country:  United States    
Other Details:
Languages:  eng     Pagination:  870-3     Citation Subset:  IM    
Ochsner Clinic Foundation, New Orleans, Louisiana 70121, USA.
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MeSH Terms
Adrenergic beta-Antagonists / therapeutic use*
Antihypertensive Agents / therapeutic use*
Hypertension / drug therapy*
Practice Guidelines as Topic*
Reg. No./Substance:
0/Adrenergic beta-Antagonists; 0/Antihypertensive Agents

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