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

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  • dc.contributor.author Vögele, Annaca
  • dc.contributor.author Johansson, Timca
  • dc.contributor.author Renom-Guiteras, Annaca
  • dc.contributor.author Reeves, Davidca
  • dc.contributor.author Rieckert, Anjaca
  • dc.contributor.author Schlender, Lisaca
  • dc.contributor.author Teichmann, Anne-Lisaca
  • dc.contributor.author Sönnichsen, Andreasca
  • dc.contributor.author Martinez, Yolanda V.ca
  • dc.date.accessioned 2018-04-17T07:18:15Z
  • dc.date.available 2018-04-17T07:18:15Z
  • dc.date.issued 2017
  • dc.description.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.
  • dc.description.sponsorship The PRIMA-eDS study was supported by a grant from the European Commission within the 7th Framework Programme (Grant No. 305388–2). The work of YVM was also supported by a grant from the NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre. The publication charge was funded by the University of Witten/Herdecke.
  • dc.format.mimetype application/pdf
  • dc.identifier.citation Vögele A, Johansson T, Renom-Guiteras A, Reeves D, Rieckert A, Schlender L. et al. Effectiveness and safety of beta blockers in the management of hypertension in older adults: a systematic review to help reduce inappropriate prescribing. BMC Geriatr. 2017 Oct 16;17(Suppl 1):224. DOI: 10.1186/s12877-017-0575-4
  • dc.identifier.doi http://dx.doi.org/10.1186/s12877-017-0575-4
  • dc.identifier.issn 1471-2318
  • dc.identifier.uri http://hdl.handle.net/10230/34377
  • dc.language.iso eng
  • dc.publisher BioMed Centralca
  • dc.relation.ispartof BMC Geriatrics. 2017 Oct 16;17(Suppl 1):224
  • dc.relation.projectID info:eu-repo/grantAgreement/EC/FP7/305388
  • dc.rights Copyright © The Author(s). 2017. Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
  • dc.rights.accessRights info:eu-repo/semantics/openAccess
  • dc.rights.uri http://creativecommons.org/licenses/by/4.0/
  • dc.subject.keyword Aged
  • dc.subject.keyword Beta blockers
  • dc.subject.keyword Effectiveness
  • dc.subject.keyword Hypertension
  • dc.subject.keyword Inappropriate prescribing
  • dc.subject.keyword Systematic review
  • dc.subject.other Hipertensió -- Tractament
  • dc.subject.other Persones grans
  • dc.title Effectiveness and safety of beta blockers in the management of hypertension in older adults: a systematic review to help reduce inappropriate prescribingca
  • dc.type info:eu-repo/semantics/article
  • dc.type.version info:eu-repo/semantics/publishedVersion

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