Physicians Rethink the Use of a Common Blood Pressure Medication By Kevin Self Reviewed by Elizabeth Klodas, MD, FACC  and   A new study reveals the use of beta blockers, a type of drug used to treat high blood pressure, may not be as effective as other, less-prescribed medications.

It has long been known that patients with high blood pressure are at increased risk of stroke, heart disease and kidney disease. The World Health Organization estimates that high blood pressure is the leading risk of death and the second leading risk for disability worldwide. 

The best way to decrease this risk is to control blood pressure. Since the late 1970s, many guidelines recommend beta blockers, medications which lower heart rate and reduce blood pressure, as a first-line therapy against chronic high blood pressure, or hypertension. In fact, beta blockers are among the most prescribed drugs in the United States for the treatment of high blood pressure. A recent study, however, suggests that they may not be as effective as first believed.

A study by a group of researchers examined the heart rates of over 12,000 patients 55 years and older with high blood pressure to see what therapy was more effective at preventing cardiovascular events (such as heart attack, stroke, angioplasty, etc.).  The heart rate consideration was central to the study because prior research has shown that higher resting heart rates are associated with a worse outcome. The patients, all without known heart disease, were offered one of two therapy programs — a regimen which included a beta blocker or one which included a calcium channel blocker, a less commonly prescribed drug also used to reduce blood pressure. The average time of follow-up was five and a half years.  The calcium channel blocker group did better.

“This study effectively demonstrates that the calcium channel blocker based therapy was superior for individuals with hypertension — regardless of their base line heart rate,” says Dr. Norm R. C. Campbell from the Dept. of Medicine at the University of Calgary and one of the authors of the study.

In an accompanying editorial, Dr. Carl J. Lavie at the Ochsner Heart and Vascular Institute in New Orleans indicates that the findings mark a fundamental shift in what is considered standard practice for physicians treating patients with hypertension.

“Beta blockers should not be a first- or second- line therapy for benign essential hypertension. Perhaps not even a third-or fourth-line therapy,” says Lavie.

So What About Patients on Beta Blockers Now?

There are many conditions for which the use of beta blockers is still the most effective form of treatment. This includes patients with established coronary artery disease, heart failure, and various rhythm disturbances — regardless of whether the patient has hypertension.

Ask your physician if beta blockers are the best treatment available given the recent findings that calcium channel blockers are more effective at reducing cardiovascular disease. Be sure to ask what conditions would make beta blockers the best therapy for you. Most importantly, never stop taking your beta blockers unless you first consult your physician. Stopping these medications abruptly can have serious consequences.

General Blood Pressure Health

If the goal is to reduce blood pressure, Dr. Campbell says patients need to understand that lifestyle modifications are also required to control their readings. This includes:

• Weight loss
• At least 30-60 minutes of moderate, daily physical activity
• A healthy diet that is high in fresh fruits, vegetables and low-fat dairy products, but low in saturated fat and sodium
• Moderate alcohol consumption
• Cessation of smoking

“In general, a healthy diet will reduce blood pressure more than any hypertension medication,” says Campbell. “And a combination of lifestyle changes is greater still, as these changes are additive — meaning the more you incorporate these changes into your life the greater cumulative benefit you can expect to gain.”

The survey results are published in the September 22, 2009 issue of the Journal of the American College of Cardiology.Sources: 

Poulter NR et al. Baseline Heart Rate, Antihypertensive Treatment, and Prevention of Cardiovascular Outcomes in the Anglo-Scandinavian Cardiac Outcomes Trial. Journal of the American College of Cardiology, 2009

Dr. Norm R. C. Campbell, Department of Medicine, University of Calgary, Canada

Carl J. Lavie, MD, Ochsner Heart and Vascular Institute, New Orleans, LA