Beta-Blockers for Primary Prevention of Heart Failure in Patients With Hypertension Insights From a Meta-Analysis

ObjectivesThis study sought to evaluate the efficacy of beta-blockers (BBs) for primary prevention of heart failure (HF) in patients with hypertension.BackgroundThe American College of Cardiology/American Heart Association staging for HF classifies patients with hypertension as stage A HF, for which BBs are a treatment option. However, the evidence to support this is unknown.MethodsWe conducted a MEDLINE/EMBASE/CENTRAL search of randomized controlled trials that evaluated BB as first-line therapy for hypertension with follow-up for at least 1 year and with data on new-onset HF. The primary outcome was new-onset HF. Secondary outcomes were all-cause mortality, cardiovascular mortality, myocardial infarction, and stroke.ResultsAmong the 12 randomized controlled trials, which evaluated 112,177 patients with hypertension, BBs reduced blood pressure by 12.6/6.1 mm Hg when compared with placebo, resulting in a 23% (trend) reduction in HF risk (p = 0.055). When compared with other agents, the antihypertensive efficacy of BBs was comparable, which resulted in similar but no incremental benefit for HF risk reduction in the overall cohort (risk ratio: 1.00; 95% confidence interval: 0.92 to 1.08), in the elderly (≥60 years) or in the young (