Effect of beta-blockers on the mortality of Japanese patients with myocardial infarction. Beta-blockers versus diuretics in hypertensive men: main results from the HAPPHY trial. The risk of myocardial infarction associated with antihypertensive drug therapies. Beta-blockers versus saluretics in hypertension. Comparison of total mortality, myocardial infarction, and sudden death: study design and early results on blood pressure reduction. Adverse outcomes of underuse of beta-blockers in elderly survivors of acute myocardial infarction. Effect of Beta-Blocker Dose on Survival After Acute Myocardial Infarction. ACE inhibitors, beta-blockers, calcium blockers, and diuretics for the control of systolic hypertension. Beta-adrenergic blockade after stroke. A preliminary closed cohort study. Randomised trial of effects of calcium antagonists compared with diuretics and β-blockers on cardiovascular morbidity and mortality in hypertension: the Nordic Diltiazem (NORDIL) study 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). The IPPPSH Collaborative Group. Mortality benefit of beta-blockade after successful elective percutaneous coronary intervention. Beta-blocker therapy for secondary prevention of myocardial infarction in elderly diabetic patients. Results from the National Cooperative Cardiovascular Project. Impact of oral beta-blocker therapy on mortality after primary percutaneous coronary intervention for Killip class 1 myocardial infarction Calcium channel blockers and cardiac mortality in the treatment of hypertension: a report from the Department of Health Hypertension Care Computing Project (DHCCP) The effects of beta-blockers on morbidity and mortality in a population-based cohort of 11,942 elderly patients with heart failure. Are beta-blockers effective in elderly patients who undergo coronary revascularization after acute myocardial infarction? Reduced cardiovascular morbidity and mortality in hypertensive diabetic patients on first-line therapy with an ACE inhibitor compared with a diuretic/beta-blocker-based treatment regimen: a subanalysis of the Captopril Prevention Project.
BACKGROUND After a myocardial infa rct ion , a higher prevalence of coronary vasospastic response has been reported in the Japanese population than in the Caucasian population . Beta-blockers may exacerbate coronary vasospasm . However , beta-blockers are given to Japanese patients after an acute myocardial infa rct ion , though the mortality benefit is unknown . Thus , we investigated the mortality benefit of beta-blockers given to Japanese patients after an acute myocardial infa rct ion . METHODS We prospect ively studied consecutive patients with a first myocardial infa rct ion admitted to the coronary care unit of Kansai Medical University Hospital , Osaka , Japan from May 1994 through the end of 2001 . Patients who died during hospitalization or who were referred for coronary artery bypass graft surgery were excluded . The association of beta-blocker use with mortality after discharge was assessed by a proportional hazards regression analysis . RESULTS There were 546 patients and 400 ( 73.3 % ) patients were treated with beta-blockers  at the time of discharge from hospital . During a mean follow-up of 2 years , 46 ( 8.4 % ) patients died . Beta-blocker therapy was associated with a reduced mortality after adjustment for age , gender , Q wave myocardial infa rct ion , reperfusion therapy during acute phase , Killip functional class , serum creatinine level , cardiovascular risk factors , and medications ( hazard ratio=0.51 , 95 % confidence interval=0.27 to 0.95 ) . CONCLUSIONS Contrary to the concern that beta-blocker therapy might induce coronary vasospasm and reduce survival , beta-blocker therapy improved survival after discharge in Japanese patients with a first myocardial infa rct ion Men aged 40 - 64 years with mild to moderate hypertension [ diastolic blood pressure ( DBP ) 100 - 130 mmHg ] were r and omized to treatment with a  diuretic ( n = 3272 ) or a  beta-blocker ( n = 3297 ) , with additional drugs if necessary , to determine whether a beta-blocker based treatment differs from thiazide diuretic based treatment with regard to the prevention of coronary heart disease ( CHD ) events and death .  Patients with previous CHD , stroke or other serious diseases , or with contraindications to diuretics or beta-blockers were excluded . If normotension ( DBP less than 95 mmHg ) was not achieved by monotherapy , other antihypertensive drugs were added , but the two basic drugs were not crossed over . Patients were assessed at 6-monthly intervals . The mean follow-up for end-points was 45.1 months . Blood pressure ( BP ) side effects and end-points were recorded in a st and ardized manner . Entry characteristics and the BP reduction achieved were very similar in both treatment groups . All analyses were made on an intention-to-treat basis . The incidence of CHD did not differ between the two treatment groups . The incidence of fatal stroke tended to be lower in the beta-blocker treated group than in the diuretic treated group . Total mortality and the total number of end-points were similar in both groups . The percentage of patients withdrawn due to side effects was similar , whereas the number of reported symptoms , according to a question naire , was higher for patients on beta-blockers . The incidence of diabetes did not differ between the two groups . Subgroup analyses did not detect a difference in the effect of beta-blockers compared with diuretics in smokers as opposed to non-smokers , and beta-blockers also had the same effects as diuretics in the quartile with the highest predicted risk for CHD . Beta-blockers and thiazide diuretics were approximately equally well tolerated . The two drugs had a similar BP reducing effect although additional drugs had to be given more often in the diuretic group . Antihypertensive treatment based on a beta-blocker or on a thiazide diuretic could not be shown to affect the prevention of hypertensive complications , including CHD , to a different extent OBJECTIVE To assess the association between  first myocardial infa rct ion and the use of antihypertensive agents .  DESIGN AND SETTING We conducted a population -based case-control study among enrollees of the Group Health Cooperative of Puget Sound ( GHC ) . PATIENTS AND METHODS Cases were hypertensive patients who sustained a first fatal or nonfatal myocardial infa rct ion from 1986 through 1993 among women and from 1989 through 1993 among men . Controls were a stratified r and om sample of hypertensive GHC enrollees , frequency matched to the cases on age , sex , and calendar year . All 623 cases and 2032 controls had pharmacologically treated hypertension . Data collection included a review of the ambulatory medical record a brief telephone interview of consenting survivors . Antihypertensive therapy was assessed using the GHC 's computerized pharmacy data base . RESULTS The first analysis included only the 335 cases and 1395 controls initially free of cardiovascular disease . Compared with users of diuretics alone , the adjusted risk ratio of myocardial infa rct ion was increased by about 60 % among users of calcium channel blockers with or without diuretic ( risk ratio = 1.62 % ; 95 % confidence interval [ Cl ] , 1.11 to 2.34 ; P = .01 ) . The second analysis was restricted to 384 cases and 1108 controls who were taking either a calcium channel blocker or a beta-blocker .  Among these subjects , the use of calcium channel blockers compared with beta-blockers was associated with about a 60 % increase in the adjusted risk of myocardial infa rct ion ( risk ratio = 1.57 ; 95 % Cl , 1.21 to 2.04 ; P < .001 ) . While high doses of beta-blockers were associated with a decreased risk of myocardial infa rct ion ( trend P = .04 ) , high doses of calcium channel blockers were associated with an increased risk ( trend P < .01 ) . CONCLUSIONS In this study of hypertensive patients , the use of short-acting calcium channel blockers , especially in high doses , was associated with an increased risk of myocardial infa rct ion . Ongoing large-scale clinical trials will assess the effect of various antihypertensive therapies , including calcium channel blockers , on several important cardiovascular end points . Until these results are available , the findings of this study support the current guidelines from the Joint National Committee on the Detection , Evaluation and Treatment of High Blood Pressure that recommend diuretics and beta-blockers as first-line agents unless contraindicated , unacceptable , or not tolerated Abstract Beta-blocking drugs may be more effective than saluretic diuretics in reducing the total mortality and incidence of myocardial infa rct ion , sudden death and stroke in middle-aged men with mild to moderate hypertension . To test this hypothesis , an international multicenter , r and omized study is in progress , and its design and some early results are presented here . It is probable that 4,000–5,000 men will need to be enrolled for five years to show a statistically significant difference between treatments . Identical control of blood pressure in the two treatment groups is m and atory , and has been achieved using a fixed therapeutic schedule . The ongoing study will be completed during 1985–1990 OBJECTIVES To study determinants and adverse outcomes ( mortality and rehospitalization ) of beta-blocker underuse in elderly patients with myocardial infa rct ion ; and whether the relative risks ( RRs ) of survival associated with beta-blocker use were comparable to those reported in the large r and omized controlled trials ( RCTs ) . SETTING New Jersey Medicare population . DESIGN Retrospective cohort design using linked Medicare and drug cl aims data from 1987 to 1992 . PATIENTS Statewide cohort of 5332 elderly 30-day acute myocardial infa rct ion ( AMI ) survivors with prescription drug coverage , of whom 3737 were eligible for beta-blockers .  MAIN OUTCOME MEASURES beta-Blocker and calcium channel blocker use in the first 90 days after discharge and mortality rates and cardiac hospital readmissions over the 2-year period after discharge , controlling for sociodemographic and baseline risk variables . RESULTS Only 21 % of eligible patients received beta-blocker therapy ; this rate remained unchanged from 1987 to 1991 . Patients were almost 3 times more likely to receive a new prescription for a calcium channel blocker than for a new beta-blocker after their AMIs . Advanced age and calcium channel blocker use predicted underuse of beta-blockers . Controlling for other predictors of survival , the mortality rate among beta-blocker recipients was 43 % less than that for nonrecipients ( RR=0.57 ; 95 % confidence interval [ CI ] , 0.47 - 0.69 ) . Effects on mortality were substantial in all age strata ( 65 - 74 years , 75 - 84 years , and > or = 85 years ) and consistent with the results for elderly subgroups of 2 large RCTs . beta-Blocker recipients were rehospitalized 22 % less often than nonrecipients ( RR=0.78 ; 95 % CI , 0.67 - 0.90 ) . Use of a calcium channel blocker instead of a beta-blocker was associated with a doubled risk of death ( RR= 1.98 ; 95 % CI , 1.44 - 2.72 ) , not because calcium channel blockers had a demonstrable adverse effect , but because they were substitutes for beta-blockers . CONCLUSIONS beta-Blockers are underused in elderly AMI survivors , leading to measurable adverse outcomes . These data suggest that the survival benefits of beta-blockade after an AMI may extend to eligible patients older than 75 years , a group that has been excluded from RCTs BACKGROUND Beta-blocker therapy after acute myocardial infa rct ion ( MI ) improves survival .  Beta-blocker doses used in clinical practice are often substantially lower than those used in the r and omized trials establishing their efficacy . OBJECTIVES This study evaluated the association of beta-blocker dose with survival after acute MI , hypothesizing that higher dose beta-blocker therapy will be associated with increased survival . METHODS A multicenter registry enrolled 7,057 consecutive patients with acute MI . Discharge beta-blocker dose was indexed to the target beta-blocker doses used in r and omized clinical trials , grouped as > 0 % to 12.5 % , > 12.5 % to 25 % , > 25 % to 50 % , and > 50 % of target dose . Follow-up vital status was assessed , with the primary endpoint of time-to-death right-censored at 2 years . Multivariable and propensity score analyses were used to account for group differences . RESULTS Of 6,682 patients with follow-up ( median 2.1 years ) , 91.5 % were discharged on a beta-blocker ( mean dose 38.1 % of the target dose ) . Lower mortality was observed with all beta-blocker doses ( p < 0.0002 ) versus no beta-blocker therapy . After multivariable adjustment , hazard ratios for 2-year mortality compared with the > 50 % dose were 0.862 ( 95 % confidence interval [ CI ] : 0.677 to 1.098 ) , 0.799 ( 95 % CI : 0.635 to 1.005 ) , and 0.963 ( 95 % CI : 0.765 to 1.213 ) for the > 0 % to 12.5 % , > 12.5 % to 25 % , and > 25 % to 50 % of target dose groups , respectively . Multivariable analysis with an extended set of covariates and propensity score analysis also demonstrated that higher doses were not associated with better outcome . CONCLUSIONS These data do not demonstrate increased survival in patients treated with beta-blocker doses approximating those used in previous r and omized clinical trials compared with lower doses . These findings provide the rationale to re-engage in research to establish appropriate beta-blocker dosing after MI to derive optimal benefit from this therapy . ( The PACE-MI Registry Study - Outcomes of Beta-blocker Therapy After Myocardial Infa rct ion [ OBTAIN ] : NCT00430612 ) The objective of this study was to determine which of the common groups of antihypertensive drugs is most effective at lowering systolic blood pressure ( SBP ) in elderly patients with previously untreated hypertension and the percentage of patients controlled with single or sequential monotherapy . Subjects were recruited from patients attending other outpatient clinics and entered into the study if their SBP was more than 150 mm Hg after three visits . Patients were given a low and high dose of each of the main classes of drugs or placebo for 1 month each . The study was a balanced , r and omized crossover design with five periods : placebo ; angiotensin converting enzyme inhibitors ; beta-blocking drugs ; calcium-blocking drugs ; and thiazide diuretics .  Blood pressure ( BP ) was measured 24 to 26 h after the previous dose . A question naire for side effects was administered at each visit . Seventy-four patients entered the study . beta-Blockers could not be used in 15 patients because of asthma or bronchospasm and these had two placebo periods . There were 9 of 66 patients on P , 9 of 46 on beta-blockers , 4 of 65 on calcium-blocking drugs , 4 of 65 on diuretic , and 1 of 62 patients on ACE inhibitors who did not progress to the higher dose because of side effects . Decreases in SBP compared to r and omized placebo were calcium-blocking drugs 15 mm Hg = diuretic 13 mm Hg > ACE inhibitors 8 mm Hg = beta-blockers 5 mm Hg . Blood pressure decrease correlated with placebo BP ( P < .0005 , r = 0.53 to 0.70 ) . When corrected for placebo , target SBP ( < 140 mm Hg ) was reached in between 6 % to 15 % of patients on monotherapy . Sequential monotherapy achieved target in 29 % . Angiotensin converting enzyme inhibitors , calcium-blocking drugs , and diuretics had no more side effects than placebo . Patients on beta-blockers had more side effects and the well-being score was reduced . Diuretics and calcium-blocking drugs are more effective in elderly patients at lowering SBP pressure . beta-Blockers were relatively ineffective , were frequently contraindicated , and had more side effects . Monotherapy achieved control in only a small number of patients . In elderly people with essential hypertension , therapy should be instituted with diuretics or calcium-blocking drugs , but combination therapy will usually be required to achieve goal To collect background data for a prospect i ve clinical trial of beta-blocking agents in the prevention of deaths after stroke , the long-term prognosis in 60 patients discharged from a stroke unit on beta-blocker therapy  was compared with the outcome in 60 matched patients with stroke but without beta-blockers .  Matching included sex , age , type of stroke , and presence or absence of hypertension and cardiac failure . Thirteen patients ( 22 % ) in the beta-blocker group died during a median followup of 41 months . Of the 60 patients not on beta-blockade at discharge , 21 ( 35 % ) died during a median followup of 36 months . By life-table technique and log-rank test , the relative risk for death was 0.60:1.00 ( p = 0.14 ) . During followup , 12 recurrent strokes were observed in patients on beta-blockers and 19 in patients without beta-blockers ( relative risk 0.57:1.00 ; p = 0.12 ) . It appeared that the reduction in mortality could only marginally be ascribed to fewer deaths from myocardial infa rct ion ; other causes of death were also less frequent in beta-blocker-treated patients . The results emphasize that supplementary information on the effect of beta-blocking agents on mortality after stroke is needed before a larger trial of beta-blocker therapy in patients with manifest cerebrovascular disease can be initiated BACKGROUND Calcium antagonists are a first-line treatment for hypertension . The effectiveness of diltiazem , a non-dihydropyridine calcium antagonist , in reducing cardiovascular morbidity or mortality is unclear . We compared the effects of diltiazem with that of diuretics , beta-blockers , or both on cardiovascular morbidity and mortality  in hypertensive patients . METHODS In a prospect i ve , r and omised , open , blinded endpoint study , we enrolled 10,881 patients , aged 50 - 74 years , at health centres in Norway and Sweden , who had diastolic blood pressure of 100 mm Hg or more . We r and omly assigned patients diltiazem , or diuretics , beta-blockers , or both . The combined primary endpoint was fatal and non-fatal stroke , myocardial infa rct ion , and other cardiovascular death . Analysis was done by intention to treat . FINDINGS Systolic and diastolic blood pressure were lowered effectively in the diltiazem and diuretic and beta-blocker groups ( reduction 20.3/18.7 vs 23.3/18.7 mm Hg ; difference in systolic reduction p<0.001 ) . A primary endpoint occurred in 403 patients in the diltiazem group and in 400 in the diuretic and beta-blocker group ( 16.6 vs 16.2 events per 1000 patient-years ; relative risk 1.00 [ 95 % CI 0.87 - 1.15 ] , p=0.97 ) . Fatal and non-fatal stroke occurred in 159 patients in the diltiazem group and in 196 in the diuretic and beta-blocker group ( 6.4 vs 7.9 events per 1000 patient-years ; 0.80 [ 0.65 - 0.99 ] , p=0.04 ) and fatal and non-fatal myocardial infa rct ion in 183 and 157 patients ( 7.4 vs 6.3 events per 1000 patient-years ; 1.16 [ 0.94 - 1.44 ] , p=0.17 ) . INTERPRETATION Diltiazem was as effective as treatment based on diuretics , beta-blockers , or both in preventing the combined primary endpoint of all stroke , myocardial infa rct ion , and other cardiovascular death Myocardial infa rct ion , sudden cardiac death , cerebrovascular accidents , blood pressure control and treatment tolerability were studied in a r and omized double-blind trial conducted in 6357 men and women aged 40 - 64 years with uncomplicated essential hypertension ( diastolic blood pressures 100 - 125 mmHg ) . At the start of the trial 3185 patients received treatment based on a beta-blocker ( oxprenolol )  , while in the remaining 3172 placebo replaced oxprenolol .  Supplementary drugs , excluding beta-blockers , were used as necessary in both treatment groups , with the aim of reducing diastolic pressure to 95 mmHg or less . Patients were followed for 3 - 5 years , a total of 25 651 patient years at risk . In most respects the two groups fared equally well ; sudden death ( relative risk [ RR ] 1.08 ; 95 % confidence interval [ Cl ] 0.68 and 1.72 ) , myocardial infa rct ion ( RR 0.83 ; Cl 0.59 and 1.16 ) and cerebrovascular accident ( RR 0.97 ; Cl 0.64 and 1.47 ) rates were similar . Beta-blocker based therapy was associated with significantly lower average blood pressures , earlier ECG normalization , less hypokalaemia and fewer withdrawals from double-blind treatment for uncontrolled hypertension . Doctor-elicited and patient-assessed unwanted effects demonstrated overall good tolerability . In smokers the cardiac event rate was doubled . We propose that beta-blocker treatment effects depend on smoking status , with a significant interaction benefiting non-smoking men . Lower blood pressures during treatment were associated with substantially lower rates for cardiac as well as cerebrovascular events . Proportional hazards analysis also underlines the importance of other cardiovascular risk factors . The IPPPSH stresses the need for a comprehensive approach to the management of blood pressure and other risk factors in hypertensive patients OBJECTIVES The goal of this study was to evaluate the mortality benefit of beta-blockers  after successful percutaneous coronary intervention ( PCI ) . BACKGROUND Beta-blockers reduce mortality after myocardial infa rct ion ( MI ) , though limited data are available regarding their role after successful PCI . METHODS Each year from 1993 through 1999 , the first 1,000 consecutive patients undergoing PCI  were systematic ally followed up . Patients presenting with acute or recent MI , shock , or unsuccessful revascularization procedures were excluded from the analysis . Clinical , procedural , and follow-up data of beta-blocker-treated and non-beta-blocker-treated patients were compared . A multivariate survival analysis model using propensity analysis was used to adjust for heterogeneity between the two groups . RESULTS Of the 4,553 patients , 2,056 ( 45 % ) were treated with beta-blockers at the time of the procedure . Beta-blocker therapy was associated with a mortality reduction from 1.3 % to 0.8 % at 30 days ( p = 0.13 ) and a reduction from 6.0 % to 3.9 % at one year ( p = 0.0014 ) . This survival benefit of beta-blockers was independent of left ventricular function , diabetic status , history of hypertension , or history of MI . Using propensity analysis , beta-blocker therapy remained an independent predictor for one-year survival after PCI ( hazard ratio , 0.63 ; 95 % confidence interval , 0.46 to 0.87 ; p = 0.0054 ) . CONCLUSIONS Within this large prospect i ve registry , beta-blocker use was associated with a marked long-term survival benefit among patients undergoing successful elective percutaneous coronary revascularization OBJECTIVES We sought to determine the use and association with one-year mortality of beta-blocker therapy for the treatment of acute myocardial infa rct ion ( AMI ) in elderly diabetic patients and to examine whether beta-blocker therapy was associated with increased rates of hospital readmission for diabetic complications traditionally associated with beta-blockers . BACKGROUND Although many r and omized trials have demonstrated that beta-blockers are effective in reducing mortality after AMI , some experts are concerned about the use of beta-blockers in diabetic patients . Little is known about the effectiveness and complication rate of beta-blocker therapy after AMI for elderly diabetics in community practice setting s. METHODS We conducted a retrospective cohort study using the National Cooperative Cardiovascular Project , which contained data abstract ed from hospital medical records of Medicare beneficiaries admitted with an AMI during 1994 and 1995 . RESULTS Out of 45,308 patients without contraindications to beta-blocker therapy , 7.4 % were insulin-treated diabetics and 18.5 % were non-insulin-treated diabetics .  Beta-blockers were prescribed at discharge for 45 % of insulin-treated diabetics , 48.1 % of non-insulin-treated diabetics and 51 % of nondiabetics ( p < 0.001 ) . After adjusting for demographic and clinical factors , diabetics continued to be less likely to receive beta-blockers at discharge compared with nondiabetics ( odds ratio [ OR ] for insulin-treated diabetics 0.88 , 95 % confidence interval [ CI ] 0.82 to 0.96 ; OR for non-insulin-treated diabetics 0.93 , 95 % CI 0.88 to 0.98 ) . After adjusting for potential confounders , beta-blockers were associated with lower one-year mortality for insulin-treated diabetics ( hazard ratio [ HR ] = 0.87 , 95 % CI 0.72 to 1.07 ) , non-insulin-treated diabetics ( HR = 0.77 , 95 % CI 0.67 to 0.88 ) and nondiabetics ( HR = 0.87 , 95 % CI 0.80 to 0.94 ) . Beta-blocker therapy was not significantly associated with increased six-month readmission rates for diabetic complications among diabetics and nondiabetics . CONCLUSIONS Beta-blockers are associated with a lower one-year mortality rate for elderly diabetic patients to a similar extent as for nondiabetics , without increased risk of readmission for diabetic complications . Increasing the use of beta-blockers in elderly diabetic patients represents an opportunity to improve the care and outcomes of these patients after AMI The use of beta-blockers therapy has been recommended to reduce mortality in patients with left ventricular dysfunction after acute myocardial infa rct ion ( AMI ) .  Primary percutaneous coronary intervention ( PCI ) , which has become the mainstay of treatment for AMI , is associated with a lower mortality than fibrinolysis . The benefits of beta-blockers after primary PCI in AMI patients without pump failure are unclear . We hypothesized that oral beta-blocker therapy after primary PCI might reduce the mortality in AMI patients without pump failure . The assessment of lipophilic vs. hydrophilic statin therapy in acute myocardial infa rct ion ( ALPS-AMI ) study was a multi-center study that enrolled 508 AMI patients to compare the efficacy of hydrophilic and lipophilic statins in secondary prevention after myocardial infa rct ion . We prospect ively tracked cardiovascular events for 3 years in 444 ALPS-AMI patients ( median age 66 years ; 18.2 % women ) who had Killip class 1 on admission and were discharged alive . The primary endpoint was all-cause mortality . The 3-year follow-up was completed in 413 patients ( 93.0 % ) . During this follow-up , 21 patients ( 4.7 % ) died . In Kaplan – Meier analysis , patients on beta-blockers had a significantly lower incidence of all-cause mortality ( 2.7 vs. 7.3 % , log-rank p = 0.025 ) . After adjusting for the calculated propensity score for using beta-blockers , their use remained an independent predictor of all-cause mortality ( hazard ratio 0.309 ; 95 % confidence interval 0.116–0.824 ; p = 0.019 ) . In the statin era , the use of beta-blocker therapy after primary PCI is associated with lower mortality in AMI patients with Killip class 1 on admission Objective : A case control study has reported a 60 % higher risk of myocardial infa rct ion in hypertensives treated with a calcium channel blocker ( CCB ) . We examined the Department of Health Hypertension Care Computing Project ( DHCCP ) data to see if we could confirm or refute this suggestion . Design : Two case control studies , matched and unmatched , plus two longitudinal studies from 1 year of presentation , one for all subjects given a CCB  for more than 1 year compared with those not given this drug , and the second comparing survival on the different drugs initially given between 3 and 12 months of follow-up . Subjects : A total of 9328 subjects were included in the analyses and 2154 died . Of these , 6406 received one or more of the following index drugs : 26 % a calcium channel blocker ( CCB ) ; 84 % a diuretic ; 29 % alpha methyldopa ; 12 % a beta-blocker ( BB ) ; and 11 % an angiotensin-converting enzyme ( ACE ) inhibitor . The CCBs were nifedipine , diltiazem or verapamil . Results : In the case control studies a group given diuretics ± other treatments ( but not including one of the index drugs ) provided a reference group with a relative risk ( RR ) of 1.0 . In the matched case control study the adjusted RR for a CCB  without a diuretic was 1.32 ( 95 % CI 0.64–2.70 ) for IHD mortality and 1.05 ( 95 % CI 0.60–1.84 ) for cardiovascular mortality . Similar results were observed for methyldopa , BBs and ACE inhibitors . The results in the unmatched case control analysis were also similar . The longitudinal study comparing all those treated for over 1 year with a CCB with all other treatments showed a RR for total mortality of 1.03 ( 95 % CI 0.85–1.25 ) . The longitudinal study of total mortality according to treatment initiated at 3–12 months found results of a similar magnitude for CCBs , methyldopa and BBs . Conclusions : The reference diuretic group had less severe cardiovascular disease than other groups . Treatment with a CCB , BB or methyldopa was associated with an excess mortality in comparison with this reference group . The excess was similar in the different drug groups PURPOSE R and omized trials have shown that beta-blockers prevent morbidity and mortality in heart failure . However , whether beta-blockers are effective in older patients or those with conditions that would have led to their exclusion from these trials remains unclear . SUBJECTS AND METHODS The associations between beta-blocker use and outcomes were examined in a population -based cohort of 11,942 older ( age > /=65 years ) patients with incident heart failure between 1994 and 1999 . Cox proportional hazards models were used to adjust for propensity scores , age , sex , comorbid conditions , and other medications . RESULTS The mean ( + /- SD ) age of the patients was 79 + /- 8 years , 5819 ( 49 % ) were men , and 2569 ( 22 % ) had Charlson comorbidity scores of at least 2 . During follow-up ( median , 21 months ) , 3539 patients were hospitalized for heart failure and 6757 died . Overall , 1162 patients received beta-blockers . After adjustment , beta-blocker use was associated with substantial reductions in all-cause mortality ( hazard ratio [ HR ] = 0.72 ; 95 % confidence interval [ CI ] : 0.65 to 0.80 ) , mortality due to heart failure ( HR = 0.65 ; 95 % CI : 0.47 to 0.90 ) , and hospitalizations for heart failure ( HR = 0.82 ; 95 % CI : 0.74 to 0.92 ) . These endpoints were less frequent in patients treated with beta-blockers than in untreated patients in all examined subgroups . All doses of beta-blockers were associated with benefit , but there was a trend towards greater benefit in patients prescribed higher doses . CONCLUSIONS The benefits of beta-blockers seen in r and omized trials extend to older patients and to those with conditions that would have led to their exclusion from the trials . There is a need for a r and omized trial comparing different doses of beta-blockers in heart failure BACKGROUND Although r and omized clinical trials have demonstrated that beta-blocker therapy is effective in reducing mortality after acute myocardial infa rct ion ( AMI ) , many of these studies excluded patients who undergo coronary revascularization . However , the clinical practice guidelines established by the American College of Cardiology and the American Heart Association recommend that beta-blocker therapy be considered for patients who underwent successful revascularization after AMI . METHODS Using data from the Cooperative Cardiovascular Project , we compared the initiation of beta-blocker therapy at discharge in patients aged 65 years or older who underwent coronary artery bypass surgery ( CABG ) or percutaneous transluminal coronary angioplasty ( PTCA ) during their hospitalization for AMI with that of patients who did not undergo revascularization . We then examined whether beta-blocker therapy was associated with lower 1-year mortality between revascularized and nonrevascularized groups . RESULTS After excluding patients with contraindications to beta-blocker therapy , 84 457 patients remained in the study sample . Of these , 8482 patients underwent CABG , and 13 997 patients underwent PTCA . After adjusting for demographic and clinical factors , we found that these patients were less likely to initiate beta-blocker therapy after CABG ( odds ratio [ OR ] , 0.44 ; 95 % confidence interval [ CI ] , 0.41 - 0.47 ) or PTCA ( OR , 0.89 ; 95 % CI , 0.85 - 0.93 ) relative to the nonrevascularized group . After adjusting for potential confounders , beta-blockers were significantly associated with lower 1-year mortality in patients who underwent CABG ( hazard ratio [ HR ] , 0.70 ; 95 % CI , 0.55 - 0.89 ) or PTCA ( HR , 0.86 ; 95 % CI , 0.74 - 1.00 ) , similar to that of the non-revascularized group ( HR , 0.83 ; 95 % CI , 0.80 - 0.87 ) . CONCLUSIONS Therapy after AMI with beta-blockers appears to be as effective in reducing 1-year mortality for elderly patients who have undergone CABG or PTCA as for a nonrevascularized group . Our findings suggest that routine use of beta-blockers should be considered for patients who undergo revascularization after AMI OBJECTIVE The Captopril Prevention Project ( CAPPP ) evaluated the effects of an ACE inhibitor-based therapeutic regimen on  cardiovascular mortality and morbidity in hypertension .  One planned sub analysis of the CAPPP was to evaluate the outcome in the diabetic patient group . RESEARCH DESIGN AND METHODS In the CAPPP , 572 ( 4.9 % of 10,985 hypertensive patients ) had diabetes at baseline and were studied according to a prospect i ve , r and omized , open , blinded , end point trial design . Patients aged 25 - 66 years with diastolic blood pressure > or = 100 mmHg were included and r and omized to receive either captopril or conventional antihypertensive treatment ( diuretics and /or beta-blockers ) . RESULTS The primary end point , fatal and nonfatal myocardial infa rct ion and stroke as well as other cardiovascular deaths , was markedly lower in the captopril than in the conventional therapy group ( relative risk [ RR ] = 0.59 ; P = 0.018 ) . Specifically , cardiovascular mortality , defined as fatal stroke and myocardial infa rct ion , sudden death , and other cardiovascular death , tended to be lower in the captopril group ( RR = 0.48 ; P = 0.084 ) , and no difference was observed between the study groups for stroke ( RR = 1.02 ; P = 0.96 ) . Myocardial infa rct ions were less frequent in the captopril group than in the conventional therapy group ( RR = 0.34 ; P = 0.002 ) . Furthermore , total mortality was lower in the captopril as compared with the conventional therapy group ( RR = 0.54 ; P = 0.034 ) . Patients with impaired metabolic control seemed to benefit the most from ACE inhibitor-based therapy . CONCLUSIONS Captopril is superior to a diuretic/beta-blocker antihypertensive treatment regimen in preventing cardiovascular events in hypertensive diabetic patients , especially in those with metabolic decompensation
Atenolol  was the beta‐blocker most used .
Current evidence suggests that initiating treatment of hypertension with beta‐blockers leads to modest CVD reductions and little or no effects on mortality .
These beta‐blocker effects are inferior to those of other antihypertensive drugs .
Abstract Background Beta‐blockers refer to a mixed group of drugs with diverse pharmacodynamic and pharmacokinetic properties .
They have shown long‐term beneficial effects on mortality and cardiovascular disease ( CVD ) when used in people with heart failure or acute myocardial infa rct ion .
Beta‐blockers were thought to have similar beneficial effects when used as first‐line therapy for hypertension .
However , the benefit of beta‐blockers as first‐line therapy for hypertension without compelling indications is controversial .
This review is an up date of a Cochrane Review initially published in 2007 and up date d in 2012 .
Objectives To assess the effects of beta‐blockers on morbidity and mortality endpoints in adults with hypertension .