Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
BMC Geriatrics
Published in: BMC Geriatrics 1/2017

Open Access 01-10-2017 | Systematic Review

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

Authors: Anna Vögele, Tim Johansson, Anna Renom-Guiteras, David Reeves, Anja Rieckert, Lisa Schlender, Anne-Lisa Teichmann, Andreas Sönnichsen, Yolanda V Martinez

Published in: BMC Geriatrics | Special Issue 1/2017

Login to get access

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.
Appendix
Available only for authorised users
Literature
1.
Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Global burden of hypertension: analysis of worldwide data. Lancet. 2005;365(9455):217–23.CrossRefPubMed
2.
Organization WH. World Health Statistics. In. Global Health Observatory (GHO) Data; 2015.
3.
Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Böhm M, Christiaens T, Cifkova R, De Backer G, Dominiczak A, et al. 2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J. 2013;34(28):2159–219.CrossRefPubMed
4.
Turnbull F, Neal B, Ninomiya T, Algert C, Arima H, Barzi F, Bulpitt C, Chalmers J, Fagard R, Gleason A, et al. Effects of different regimens to lower blood pressure on major cardiovascular events in older and younger adults: meta-analysis of randomised trials. BMJ. 2008;336(7653):1121–3.CrossRefPubMed
5.
Staessen JA, Gasowski J, Wang JG, Thijs L, Den Hond E, Boissel JP, Coope J, Ekbom T, Gueyffier F, Liu L, et al. Risks of untreated and treated isolated systolic hypertension in the elderly: meta-analysis of outcome trials. Lancet. 2000;355(9207):865–72.CrossRefPubMed
6.
Vasan RS, Beiser A, Seshadri S, Larson MG, Kannel WB, D'Agostino RB, Levy D. Residual lifetime risk for developing hypertension in middle-aged women and men: The Framingham Heart Study. JAMA. 2002;287(8):1003–10.CrossRefPubMed
7.
Lewington S, Clarke R, Qizilbash N, Peto R, Collins R, Collaboration PS. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002;360(9349):1903–13.CrossRefPubMed
8.
9.
Chien CC, Yen CS, Wang JJ, Chen HA, Chou MT, Chu CC, Chio CC, Hwang JC, Wang HY, Lu YH, et al. Reverse epidemiology of hypertension-mortality associations in hemodialysis patients: a long-term population-based study. Am J Hypertens. 2012;25(8):900–6.CrossRefPubMed
10.
Oates DJ, Berlowitz DR, Glickman ME, Silliman RA, Borzecki AM. Blood pressure and survival in the oldest old. J Am Geriatr Soc. 2007;55(3):383–8.CrossRefPubMed
11.
Perry HM, Davis BR, Price TR, Applegate WB, Fields WS, Guralnik JM, Kuller L, Pressel S, Stamler J, Probstfield JL. Effect of treating isolated systolic hypertension on the risk of developing various types and subtypes of stroke: the Systolic Hypertension in the Elderly Program (SHEP). JAMA. 2000;284(4):465–71.CrossRefPubMed
12.
Group JS. Principal results of the Japanese trial to assess optimal systolic blood pressure in elderly hypertensive patients (JATOS). Hypertens Res. 2008;31(12):2115–27.CrossRef
13.
Onder G, Landi F, Fusco D, Corsonello A, Tosato M, Battaglia M, Mastropaolo S, Settanni S, Antocicco M, Lattanzio F. Recommendations to prescribe in complex older adults: results of the CRIteria to assess appropriate Medication use among Elderly complex patients (CRIME) project. Drugs Aging. 2014;31(1):33–45.CrossRefPubMed
14.
Capuano A, Irpino A, Gallo M, Ferrante L, Illiano ML, Rinaldi B, Filippelli A, Rossi F. Regional surveillance of emergency-department visits for outpatient adverse drug events. Eur J Clin Pharmacol. 2009;65(7):721–8.CrossRefPubMed
15.
Ruiter R, Visser LE, Rodenburg EM, Trifirò G, Ziere G, Stricker BH. Adverse drug reaction-related hospitalizations in persons aged 55 years and over: a population-based study in the Netherlands. Drugs Aging. 2012;29(3):225–32.CrossRefPubMed
16.
Moderately elevated blood pressure: a Report from the SBU the Swedish Council on Technology Assessments in Health Care. revision of the SBU Report from 2004. No 170/1U. In.: Swedish Council on Technology Assessment in Health Care; 2008.
17.
Wiysonge SC, Bradley HA, Volmink J, Mayosi BM, Mbewu A, Opie LH. Beta-blockers for hypertension. Cochrane Database Syst Rev. 2012;11
18.
Messerli FH. The age factor in hypertension. Hosp Pract (Off Ed). 1986;21(1):103–5. 109-112CrossRef
19.
Higgins JPT GS. Cochrane Handbook for Systematic Reviews of Intervention Versions 5.1.0 [updated March 2011]. The Cochrane Collaboration; 2011. http://​handbook.​cochrane.​org/. last accessed 20 Jan 2016.
20.
Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009;339:b2700.CrossRefPubMedPubMedCentral
21.
Martinez YM, Renom-Guiteras A, Reeves D, Ediriweera de Silva RE, Esmail A, Kunnamo I, Rieckert A, Sommerauer C, Sönnichsen A. A set of systematic reviews to help reduce inappropriate. BMC Geriatrics. 2017;17(1). In press.
22.
Wiysonge CS, Bradley HA, Volmink J, Mayosi BM, Opie LH. Beta-blockers for hypertension. Cochrane Database Syst Rev. 2017;1:CD002003.PubMed
23.
Sönnichsen A, Trampisch US, Rieckert A, Piccoliori G, Vögele A, Flamm M, Johansson T, Esmail A, Reeves D, Löffler C, et al. Polypharmacy in chronic diseases-Reduction of Inappropriate Medication and Adverse drug events in older populations by electronic Decision Support (PRIMA-eDS): study protocol for a randomized controlled trial. Trials. 2016;17:57.CrossRefPubMedPubMedCentral
24.
Shea BJ, Grimshaw JM, Wells GA, Boers M, Andersson N, Hamel C, Porter AC, Tugwell P, Moher D, Bouter LM. Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC Med Res Methodol. 2007;7:10.CrossRefPubMedPubMedCentral
25.
Shea BJ, Hamel C, Wells GA, Bouter LM, Kristjansson E, Grimshaw J, Henry DA, Boers M. AMSTAR is a reliable and valid measurement tool to assess the methodological quality of systematic reviews. J Clin Epidemiol. 2009;62(10):1013–20.CrossRefPubMed
26.
Higgins JPT DG, Jonathan ACS. Chapter 8: Assessing risk of bias in included studies in Cochrane Handbook for Systematic Reviews of Interventions http://​handbook.​cochrane.​org/​chapter 8/8 assessing risk of bias in included studies.htm. last accessed 20 Jan 2016. In.
27.
28.
29.
30.
Guyatt GH, Oxman AD, Kunz R, Falck-Ytter Y, Vist GE, Liberati A, Schünemann HJ, Group GW. Going from evidence to recommendations. BMJ. 2008;336(7652):1049–51.CrossRefPubMedPubMedCentral
31.
Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, Schünemann HJ, Group GW. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336(7650):924–6.CrossRefPubMedPubMedCentral
32.
Guyatt GH, Oxman AD, Kunz R, Vist GE, Falck-Ytter Y, Schünemann HJ, Group GW. What is "quality of evidence" and why is it important to clinicians? BMJ. 2008;336(7651):995–8.CrossRefPubMedPubMedCentral
33.
Khan N, McAlister FA. Re-examining the efficacy of beta-blockers for the treatment of hypertension: A meta-analysis. Can Med Assoc J. 2006;174(12):1737–42.CrossRef
34.
Pepine CJ, Handberg EM, Cooper-DeHoff RM, Marks RG, Kowey P, Messerli FH, Mancia G, Cangiano JL, Garcia-Barreto D, Keltai M, et al. A calcium antagonist vs a non-calcium antagonist hypertension treatment strategy for patients with coronary artery disease. The International Verapamil-Trandolapril Study (INVEST): a randomized controlled trial. JAMA. 2003;290(21):2805–16.CrossRefPubMed
35.
Medical Research Council trial of treatment of hypertension in older adults: principal results. MRC Working Party. BMJ 1992;304(6824):405–412.
36.
Bird AS, Blizard RA, Mann AH. Treating hypertension in the older person: an evaluation of the association of blood pressure level and its reduction with cognitive performance. J Hypertens. 1990;8(2):147–52.CrossRefPubMed
37.
Coope J, Warrender TS. Randomised trial of treatment of hypertension in elderly patients in primary care. Br Med J (Clin Res Ed). 1986;293(6555):1145–51.CrossRef
38.
Duodecim Medical Publications Ltd. EBM Guidelines [Internet]: ebm00759 Cerebral Infarction (ischaemic stroke). Helsinki [updated 2013 May17;cited 2016 June 15]. Available from http://​www.​ebm-guidelines.​com. In.
39.
Lever AF, Brennan PJ. MRC trial of treatment in elderly hypertensives. Clin Exp Hypertens (New York). 1993;15(6):941–52.
40.
Ruwald AC, Westergaard B, Sehestedt T, Kjeldsen SE, Lindholm LH, Wachtell K, Devereux RB, Ibsen H, Nieminen MS, Dahlof B, et al. Losartan versus atenolol-based antihypertensive treatment reduces cardiovascular events especially well in elderly patients: the Losartan Intervention For Endpoint reduction in hypertension (LIFE) study. J Hypertens. 2012;30(6):1252–9.CrossRefPubMed
41.
Ogihara T, Matsuzaki M, Umemoto S, Rakugi H, Matsuoka H, Shimada K, Higaki J, Ito S, Kamiya A, Suzuki H, et al. Combination therapy for hypertension in the elderly: a sub-analysis of the Combination Therapy of Hypertension to Prevent Cardiovascular Events (COPE) Trial. Hypertens Res. 2012;35(4):441–8.CrossRefPubMed
42.
Carr MJ, Bao Y, Pan J, Cruickshank K, McNamee R. The predictive ability of blood pressure in elderly trial patients. J Hypertens. 2012;30(9):1725–33.CrossRefPubMed
43.
Carlsson AC, Wandell P, Sundquist K, Johansson SE, Sundquist J. Effects of prescribed antihypertensives and other cardiovascular drugs on mortality in patients with atrial fibrillation and hypertension: a cohort study from Sweden. Hypertens Res Clin Exp. 2014;37(6):553–9.CrossRef
44.
Collier DJ, Poulter NR, Dahlof B, Sever PS, Wedel H, Buch J, Caulfield MJ, Investigators A. Impact of amlodipine-based therapy among older and younger patients in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA). J Hypertens. 2011;29(3):583–91.CrossRefPubMed
45.
Gelber RP, Ross GW, Petrovitch H, Masaki KH, Launer LJ, White LR. Antihypertensive medication use and risk of cognitive impairment: the Honolulu-Asia Aging Study. Neurology. 2013;81(10):888–95.CrossRefPubMedPubMedCentral
46.
Testa G, Cacciatore F, Della-Morte D, Mazzella F, Mastrobuoni C, Galizia G, Gargiulo G, Rengo F, Bonaduce D, Abete P. Atenolol use is associated with long-term mortality in community-dwelling older adults with hypertension. Geriatr Gerontol Int. 2014;14(1):153–8.CrossRefPubMed
47.
Matsuzaki M, Ogihara T, Umemoto S, Rakugi H, Matsuoka H, Shimada K, Abe K, Suzuki N, Eto T, Higaki J, et al. Prevention of cardiovascular events with calcium channel blocker-based combination therapies in patients with hypertension: a randomized controlled trial. J Hypertens. 2011;29(8):1649–59.CrossRefPubMed
48.
Lever AF. BPJ: MRC trial of treatment in elderly hypertensives. High Blood Press. 1992;1:132–7.CrossRef
49.
Chen MHJ, Heran BS, Perez MI, Wright JM. Blood pressure lowering efficacy of beta-blockers as second-line therapy for primary hypertension. Cochrane Database Syst Rev. 2010;1
50.
De Lima GL, Soares GOB, Saconato H, Atallah AN, da Silva MKE. Beta-blockers for preventing stroke recurrence. Cochrane Database Syst Rev. 2013;5
51.
Hackam DG, Khan NA, Hemmelgarn BR, Rabkin SW, Touyz RM, Campbell NR, Padwal R, Campbell TS, Lindsay MP, Hill MD, et al. The 2010 Canadian Hypertension Education Program recommendations for the management of hypertension: part 2 - therapy. Can J Cardiol. 2010;26(5):249–58.CrossRefPubMedPubMedCentral
52.
Leung AA, Nerenberg K, Daskalopoulou SS, McBrien K, Zarnke KB, Dasgupta K, Cloutier L, Gelfer M, Lamarre-Cliche M, Milot A, et al. Hypertension Canada's 2016 Canadian Hypertension Education Program Guidelines for Blood Pressure Measurement, Diagnosis, Assessment of Risk, Prevention, and Treatment of Hypertension. Can J Cardiol. 2016;32(5):569–88.CrossRefPubMed
53.
Dahlof B, Devereux RB, Kjeldsen SE, Julius S, Beevers G, De Faire U, Fyhrquist F, Ibsen H, Kristiansson K, Lederballe-Pedersen O, et al. Cardiovascular morbidity and mortality in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): A randomised trial against atenolol. Lancet. 2002;359(9311):995–1003.CrossRefPubMed
54.
Kuyper LM, Khan NA. Atenolol vs nonatenolol beta-blockers for the treatment of hypertension: a meta-analysis. Can J Cardiol. 2014;30:S47–53.CrossRefPubMed
55.
Moher D, Hopewell S, Schulz KF, Montori V, Gøtzsche PC, Devereaux PJ, Elbourne D, Egger M, Altman DG. CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials. BMJ. 2010;340:c869.CrossRefPubMedPubMedCentral
56.
Dahlöf B, Devereux R, de Faire U, Fyhrquist F, Hedner T, Ibsen H, Julius S, Kjeldsen S, Kristianson K, Lederballe-Pedersen O, et al. The Losartan Intervention For Endpoint reduction (LIFE) in Hypertension study: rationale, design, and methods. The LIFE Study Group. Am J Hypertens. 1997;10(7 Pt 1):705–13.PubMed
Metadata
Title
Effectiveness and safety of beta blockers in the management of hypertension in older adults: a systematic review to help reduce inappropriate prescribing
Authors
Anna Vögele
Tim Johansson
Anna Renom-Guiteras
David Reeves
Anja Rieckert
Lisa Schlender
Anne-Lisa Teichmann
Andreas Sönnichsen
Yolanda V Martinez
Publication date
01-10-2017
Publisher
BioMed Central
Published in
BMC Geriatrics / Issue Special Issue 1/2017
Electronic ISSN: 1471-2318
DOI
https://doi.org/10.1186/s12877-017-0575-4

Other articles of this Special Issue 1/2017

BMC Geriatrics 1/2017 Go to the issue

Systematic Review

Effectiveness and safety of vitamin K antagonists and new anticoagulants in the prevention of thromboembolism in atrial fibrillation in older adults – a systematic review of reviews and the development of recommendations to reduce inappropriate prescribing

Systematic Review

Efficacy and safety of metformin in the management of type 2 diabetes mellitus in older adults: a systematic review for the development of recommendations to reduce potentially inappropriate prescribing

Systematic Review

Effectiveness and patient safety of platelet aggregation inhibitors in the prevention of cardiovascular disease and ischemic stroke in older adults – a systematic review

Study protocol

A set of systematic reviews to help reduce inappropriate prescribing to older people: study protocol

Systematic Review

Effectiveness and safety of dipeptidyl peptidase 4 inhibitors in the management of type 2 diabetes in older adults: a systematic review and development of recommendations to reduce inappropriate prescribing

Systematic Review

Thiazides in the management of hypertension in older adults – a systematic review

ACC 2024 Congress Coverage

Heart Failure Video

Year in Review: Heart failure and cardiomyopathies

Watch now

Watch this official video from ACC.24 to hear Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits