ARE BETA-BLOCKERS EFFICACIOUS AS FIRST-LINE THERAPY FOR HYPERTENSION IN THE ELDERLY - A SYSTEMATIC REVIEW

Objective.-To assess antihypertensive efficacy of beta-blockers and th eir effects on cardiovascular morbidity and mortality and all-cause mo rbidity compared with diuretics in elderly patients with hypertension. Data Source.-A MEDLINE search of English-language articles published between January 1966 and January 1998 using the terms hypertension (dr ug therapy) and elderly or aged or geriatric, and cerebrovascular or c ardiovascular diseases, and morbidity or mortality. References from id entified articles were also reviewed. Data Selection.-Randomized trial s lasting at least 1 year, which used as first-line agents diuretics a nd/or beta-blockers, and reported morbidity and mortality outcomes in elderly patients with hypertension. Data Synthesis and Results.-Ten tr ials involving a total of 16 164 elderly patients (greater than or equ al to 60 years) were included. Two thirds of the patients assigned to diuretics were well controlled on monotherapy, whereas less than a thi rd of the patients assigned to beta-blockers were well controlled on m onotherapy. Diuretic therapy was superior to beta-blockade with regard to all end points and was effective in preventing cerebrovascular eve nts (odds ratio [OR], 0.61; 95% confidence interval [CI], 0.51-0.72), fatal stroke (OR, 0.67; 95% CI, 0.49-0.90), coronary heart disease (OR , 0.74; 95% CI, 0.64-0.85), cardiovascular mortality (OR, 0.75; 95% CI , 0.64-0.87), and all-cause mortality (OR, 0.86; 95% CI, 0.77-0.96). I n contrast, beta-blocker therapy only reduced the odds for cerebrovasc ular events (OR, 0.75; 95% CI, 0.57-0.98) but was ineffective in preve nting coronary heart disease, cardiovascular mortality, and all-cause mortality (ORs, 1.01, 0.98, and 1.05, respectively). Conclusions.-In c ontrast to diuretics, which remain the standard first-line therapy, be ta-blockers, until proven otherwise, should no longer be considered ap propriate first-line therapy of uncomplicated hypertension in the elde rly hypertensive patient.