Beta-blocker drugs such as Tenormin (atenolol), Inderal (propranolol) and Lopressor (metoprolol) should not be a doctor’s first choice for treating high blood pressure, according to a major review of studies.

The research, details of which appear in the latest issue of The Cochrane Library and carried out by The Cochrane Collaboration, found that patients on beta-blockers had a higher risk of death and cardiovascular disease than

patients who used calcium channel blockers such as Norvasc (amlodipine) and Cardizem (diltiazem) to manage their blood pressure. The review also found that patients who took diuretics such as hydrochlorothiazide or RAS inhibitors, such as Altace (ramipril), and Cozaar (losartan), had risks similar to those taking beta-blockers.

Dr Charles Shey Wiysonge of the Ministry of Public Health in Cameroon, who led the new review, said that “the available evidence does not support the use of beta-blockers as first-line drugs in the treatment of hypertension”. He added that the latest Cochrane review of beta-blockers was different from other recent studies because it compared beta-blockers head-to-head against specific antihypertensive medications, rather than comparing them against all other high blood pressure medicines as a group.

After combing through 13 studies of 91,561 patients, Dr Wiysonge and colleagues found no difference in the risk of death or cardiovascular disease among those who used beta-blockers, diuretics and RAS inhibitor drugs.

However, the absolute risk of death was a half a per cent greater among

beta-blocker users compared to those taking calcium channel blockers.

In addition, patients taking beta-blockers had a 1.3% increase in the

risk of cardiovascular disease, mostly strokes, compared to those taking

calcium channel blockers. Dr Wiysonge also noted that “patients who used beta-blockers were more likely to experience undesirable effects and abandon their antihypertension medications” compared to patients who took diuretics or RAS inhibitors.

In January this year, a review of 22 studies published in The Lancet suggested another downside to using beta-blockers to treat high blood pressure. Researchers from Rush University Medical Center in Chicago concluded that diuretics and beta-blocker treatments may increase the chances of developing type 2 diabetes.

Lead author Dr William Elliott said antihypertensive drugs such as ACE

inhibitors and angiotensin receptor blockers — types of RAS drugs — were

associated with the lowest risk of developing diabetes. Michael Day