Use of Third-Generation b-Blockers as First-Line Treatment for Hypertension is Risky Business, New Study Says
Update 22.12.2022
Researchers associate third-generation b-blockers with an inferior protective effect against stroke in patients with high blood pressure
Hypertension or high blood pressure can
cause serious physiological consequences such as organ damage if not managed
properly. While b-blockers are routinely prescribed as first-line
treatment, evidence for their safety and efficacy
is lacking. Now, a new study by Korean
researchers identifies higher risk of stroke for patients on third-generation b-blockers compared with other recommended
medications, providing important insights in the proper treatment and control
of hypertension.
Researchers from KNIH reveal in a new study that, contrary
to expectations, third-generation b-blockers do not provide enough protection
against stroke in patients of hypertension.
Photo
credit: Horacio Selva from Shutterstock.
Keeping
hypertension or high blood pressure in check often requires not only adopting a
series of dietary and lifestyle changes but also opting for standard
prescription-based medications. Clinicians routinely prescribe b-blockers as first-line treatment for lowering
blood pressure. However, their efficacy and safety has remained unverified so
far. This is particularly concerning in light of the fact that b-blockers have been shown to be inferior compared
with other medications recommended for hypertension, such as
angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers
(ARBs), calcium-channel blockers (CCBs), and thiazide-like diuretics (TDs).
One explanation for the reported inferiority has
been that the previous studies have only considered second-generation b-blockers, which do not produce vasodilating
effects (the dilatation of blood vessels to reduce blood pressure). It is
postulated that third-generation b-blockers, which produce vasodilation, could fare
better in treating hypertension compared to their second-generation
counterparts.
To verify this claim, a group of international researchers,
led by Professor Sungha Park and Assistant Professor Seng Chan You from Korea, recently
conducted a study to determine the safety and effectiveness of third-generation
b-blockers
compared with atenolol, as part of a Large-Scale Evidence Generation and
Evaluation Across a Network of Databases for Hypertension (LEGEND-HTN) project.
This study was supported by the Korean Centers for Disease Control and Prevention
(2018-ER6302-01 to S. Park) and was published in the journal Hypertension.
In their study, the research team accessed three
U.S. databases containing administrative claims and electronic health records
of eligible patients on third-generation b-blockers between 2001 and 2018. Using specialized
quantitative techniques, the team estimated the risk for acute myocardial
infarction, stroke, hospitalization due to heart failure, and other metabolic
complications among these patients and combined the estimates across databases
using a random-effects meta-analysis model.
Interestingly, the findings, based on the analyses
of 118,133 patients on carvedilol and nebivolol and 267,891 patients on
atenolol, revealed that the estimated risks for acute myocardial infarction,
stroke, hospitalization due to heart failure, and most other metabolic
complications were similar to atenolol for all the third-generation β-blockers.
However, contrary to the expectation, the third-generation β-blockers were associated
with an inferior protective effect against stroke. “Patients on
third-generation β-blockers showed, in fact, a greater risk of stroke compared
to those administered ACE inhibitors and TDs,” explains Prof. Park.
Although not without limitations, the study
undoubtedly raises a red flag regarding the recommendation of third-generation β-blockers as first-line therapy, providing an important cue to
clinicians, biomedical researchers, and medical associations. However, we
should keep in mind that beta blockers are still important first-line treatment
for ischemic heart disease, heart failure and tachyarrhythmia. “Given
the prevalence of β-blockers as a first-line anti-hypertensive medication, we
hope that our findings would lead to a better control of hypertension, and
facilitate a decrease in the prevalence of stroke worldwide,” concludes Dr. Chan You.
That, certainly, is a consequence to look forward
to!
Reference
Authors
|
Seng Chan You1, Harlan M. Krumholz2,
Marc A. Suchard3, Martijn J. Schuemie3, George Hripcsak4,5,
RuiJun Chen4, Steven Shea4, Jon Duke6,
Nicole Pratt7, Christian G. Reich8, David Madigan9,
Patrick B. Ryan4, Rae Woong Park10, Sungha Park11
|
Title of
original paper |
Comprehensive Comparative Effectiveness and
Safety of First-Line b-Blocker Monotherapy in Hypertensive Patients
|
Journal |
Hypertension |
DOI |
10.1161/HYPERTENSIONAHA.120.16402 |
Affiliations |
1Department
of Biomedical Informatics, Ajou University School of Medicine, Suwon, Korea
(S.C.Y., R.W.P.); Department of Preventive Medicine and Public Health
(S.C.Y.), Yonsei University College of Medicine 3Department of Biostatistics, Department of Biomathematics, David Geffen School of Medicine at
University of California 4Department of Biomedical Informatics, Columbia University Irving
Medical Center 5Medical Informatics Services, New
York-Presbyterian Hospital. 6Georgia Tech Research Institute, Georgia Tech College of
Computing 7Quality
Use of Medicines and Pharmacy Research Centre, Clinical and Health Sciences,
University of South Australia 8Real World
Solutions, IQVIA 9Department of Statistics,
Columbia University 10Department
of Biomedical Informatics, Ajou University School of Medicine 11Sungha Park, Division of
Cardiology, Severance Cardiovascular Hospital and Integrated Research Center
for Cerebrovascular and Cardiovascular diseases, Yonsei University College of
Medicine |
About
National Institute of Health in Korea
The Korea
National Institute of Health (KNIH), one of the major operating components of
the Korea Disease Control and Prevention Agency, leads the nation’s medical
research. Over the past seven decades, the KNIH has made unwavering efforts to
enhance the public’s health and innovate biomedical research. The KNIH seeks to
eradicate diseases and make people healthier. The KNIH establishes a scientific
basis and evidence underlying health policy as well as provides national
research infrastructures. We also promote public health research. To this end,
we make efforts to enrich a health research environment by granting funds to
research projects and keeping our resources, data, and facilities more open and
accessible to researchers.
Website:
http://www.nih.go.kr/eng/
About Professor
Sungha Park and Dr. Seng Chan You
Dr. Sungha
Park is a Professor in the Division of Cardiology at Yonsei University College
of Medicine, South Korea. One of the most prominent and well-cited Korean
researchers working in the field of hypertension, Dr. Park has over 300
publications to his credit.
Dr. Seng Chan You is
an Assistant Professor in the Department of Preventive Medicine at Yonsei University
College of Medicine. He received his Ph.D. at the Department of Biomedical
Informatics, Ajou University, South Korea, and recently received the 2021
Wunsch Young Investigator Award. He has published 109 papers with over 1100
citations to his credit.