Effects of β-blocker selectivity on blood pressure variability and stroke
- 23 August 2011
- journal article
- review article
- Published by Ovid Technologies (Wolters Kluwer Health) in Neurology
- Vol. 77 (8), 731-737
- https://doi.org/10.1212/wnl.0b013e31822b007a
Abstract
Objectives: β-Blockers increase variability in systolic blood pressure (SBP), which probably explains their lesser effectiveness in preventing stroke vs myocardial infarction compared with other agents. This increase in variability in blood pressure (BP) may be particularly marked on non-cardioselective agents, potentially calling into question the widespread first-line use of propranolol in migraine with aura, elderly patients with essential tremor or anxiety, and other groups at risk of stroke. Methods: We determined β-blocker subclass effects on variability in BP and stroke risk in a systematic review of randomized controlled trials (RCTs) comparing different types of β-blocker with placebo or other agents. We determined pooled estimates of the effect of treatment on group variability in BP (ratio of the variances [VR]) and on the risk of stroke vs myocardial infarction during follow-up. Results: Compared with other antihypertensives, variability in SBP was increased more by nonselective β-blockers (VR=1.34, 1.13–1.59, p =0.002, 25 comparisons, 9,992 patients) than by β1-selective agents (VR=1.09, 95% confidence interval 1.00–1.19, p =0.053, 68 comparisons, 40,746 patients; difference-p =0.038). In direct comparisons, variability in SBP was also significantly lower with β1-selective vs nonselective β-blockers (VR=0.81, 0.68–0.97, p =0.03, 18 comparisons, 954 patients). In comparisons with other antihypertensives, the increase in stroke risk with nonselective β-blockers ([OR]=2.29, 1.32–3.96, p =0.002) was more marked than with β1-selective agents (OR=1.24, 1.08–1.42, p =0.003, difference-p =0.03), as was the risk of stroke relative to the risk of myocardial infarction: OR=1.50 (0.93–2.42) vs 0.99 (0.82–1.19). Conclusion: Use of β1-selective rather than nonselective agents may be advisable when β-blockers are indicated for patients at risk of stroke. Neurology® 2011;77:731–737Keywords
This publication has 26 references indexed in Scilit:
- Limitations of the usual blood-pressure hypothesis and importance of variability, instability, and episodic hypertensionThe Lancet, 2010
- Prognostic significance of visit-to-visit variability, maximum systolic blood pressure, and episodic hypertensionThe Lancet, 2010
- Migraine and cardiovascular disease: systematic review and meta-analysisBMJ, 2009
- Efficacy and Tolerability of Nebivolol Compared with Other Antihypertensive DrugsAmerican Journal of Cardiovascular Drugs, 2008
- Essential tremor—the most common movement disorder in older peopleAge and Ageing, 2006
- Medical Research Council trial of treatment of hypertension in older adults: principal results. MRC Working Party.BMJ, 1992
- Cardiovascular Risk and Risk Factors in a Randomized Trial of Treatment Based on the Beta-Blocker Oxprenolol: The International Prospective Primary Prevention Study in Hypertension (IPPPSH)Journal Of Hypertension, 1985
- MRC trial of treatment of mild hypertension: principal results. Medical Research Council Working Party.BMJ, 1985
- Timolol-Induced Reduction in Mortality and Reinfarction in Patients Surviving Acute Myocardial InfarctionNew England Journal of Medicine, 1981