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. 2017 Oct 16;17(Suppl 1):224.
doi: 10.1186/s12877-017-0575-4.

Effectiveness and safety of beta blockers in the management of hypertension in older adults: a systematic review to help reduce inappropriate prescribing

Anna Vögele  1 , Tim Johansson  2 , Anna Renom-Guiteras  3   4 , David Reeves  5 , Anja Rieckert  3 , Lisa Schlender  3 , Anne-Lisa Teichmann  3 , Andreas Sönnichsen  3 , Yolanda V Martinez  5
Affiliations

Effectiveness and safety of beta blockers in the management of hypertension in older adults: a systematic review to help reduce inappropriate prescribing

Anna Vögele et al. BMC Geriatr. .

Abstract

Background: The benefit from a blood pressure lowering therapy with beta blockers may not outweigh its risks, especially in older populations. The aim of this study was to look for evidence on risks and benefits of beta blockers in older adults and to use this evidence to develop recommendations for the electronic decision support tool of the PRIMA-eDS project.

Methods: Systematic review of the literature using a stage approach with searches for systematic reviews and meta-analyses first, and individual studies only if the previous searches are inconclusive. The target population were older adults (≥65 years old) with hypertension. We included studies reporting on the effectiveness and/or safety of beta blockers on clinically relevant endpoints (e.g. mortality, cardiovascular events, and stroke) in the management of hypertension. The recommendations were developed according to the GRADE methodology.

Results: Fifteen studies were included, comprising one meta-analysis, four randomized controlled trials, six secondary analyses of randomized controlled trials and four observational studies. Seven studies involved only older adults and eight studies reported subgroup analyses by age. With regard to a composite endpoint (death, stroke or myocardial infarction) beta blockers were associated with a higher risk of events then were other antihypertensive agents. Further, beta blockers showed no benefit compared to other antihypertensive agents or placebo regarding mortality. They appear to be less effective than other antihypertensive agents in reducing cardiovascular events. Contradictory results were found regarding the effect of beta blockers on stroke. None of the studies explored the effect on quality of life, hospitalisation, functional impairment/status, safety endpoints or renal failure.

Conclusion: The quality of current evidence to interpret the benefits of beta blockers in hypertension is rather weak. It cannot be recommended to use beta blockers in older adults as first line agent for hypertension.

Keywords: Aged; Beta blockers; Effectiveness; Hypertension; Inappropriate prescribing; Systematic review.

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The authors declare that they have no competing interests.

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Figures

Fig. 1
Fig. 1
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram
Fig. 2
Fig. 2
Quality appraisal for intervention studies. RCT = randomized controlled trial, LR = low risk of bias, HR = high risk of bias, UR = unclear (insufficient information to permit judgement of low risk or high risk), ITT = intention-to-treat analysis, COPE = Combination Therapy of Hypertension to Prevent Cardiovascular Events, MRC = Medical Research Council. 1 Risk of bias assessed on study protocol [56]
See this image and copyright information in PMC

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