Β-Blockers And Hypertension: Where Are The Data?

Citation: Parker ED, Margolis KL, Trower NK, et al. Comparative Effectiveness of 2 β-Blockers in Hypertensive Patients. Arch Intern Med 2012: 172: 1406-12.
Category: Hypertension
Original commentary found in iForumRx.com, written by: Jenna M. Siskey, PharmD, Adraine L. Lyles, PharmD, BCPS, and Dave L. Dixon, PharmD, BCPS

Commentary Written By: Livia Macedo, PharmD

This study compares both B-blockers atenolol and metoprolol tartrate in patients without compelling indications. Compelling indications in which B-blocker therapy is recommended includes heart failure with reduce ejection fraction, acute myocardial infarction, high coronary disease risk, and diabetes. Currently, in JNC 7, B-blockers are recommended as second line in these patients, after a thiazide diuretic, and equally recommended as ACEI, angiotensin II receptor blockers, and calcium channel blockers. However, the 2007 American Heart Association recommends B-blockers as 3rd or 4th line for the treatment of hypertension in these patients. The results of the study by Parker, et al. showed there was no difference between atenolol and metoprolol tartrate in reducing MI, HF, stroke, or cardiovascular event in patients with hypertension without compelling indications. I personally would recommend B-blockers as a 3rd or 4th line in patients with hypertension without compelling indications. I would first recommend thiazide diuretic, ACEI or ARB, and CCB. Then, if needed would recommend a B-blocker such as atenolol rather than metoprolol tartrate because of its once daily dosing; and would recommend metoprolol tartrate as an alternative option if atenolol is not appropriate for the patient. What would you do?

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