H ypertension is exceedingly preva- lent, with an age-standardized pre- valence rate in the US of 28.9%. 1 Ap- proximately 61% of the hypertensive population is receiving antihypertensive drug therapy. Because treatment with blood pressure–lowering medications provides morbidity and mortality bene- fits in individuals with hypertension, 2 it is important to consider the benefits of guideline-recommended antihyperten- sive therapy on cardiovascular (CV) and cerebrovascular outcomes. β-Adrenergic antagonists, although originally developed to relieve angina, have been used to lower blood pressure for several decades. The National High Blood Pressure Education Program has recommended β-blockers as preferred first- or second-line antihypertensive drug therapy in the treatment of hypertension since 1977. 2-7 The current seventh report of the Joint National Committee on Detec- tion, Evaluation, and Treatment of High Blood Pressure (JNC 7) recommends thi- azide diuretics as the preferred therapy for hypertension without compelling indica- tions, but β-blockers are recommended as β -Adrenergic Antagonists in Hypertension: A Review of the Evidence T Scott Warmack, Mark A Estes, Seth Heldenbrand, and Amy M Franks Hypertension Author information provided at the end of the text. The Annals of Pharmacotherapy ■ 2009 December, Volume 43 ■ 2031 theannals.com OBJECTIVE: To evaluate the effects of β-adrenergic antagonist therapy on cardio- vascular and cerebrovascular outcomes in the treatment of hypertension. DATA SOURCES: Literature searches were conducted using MEDLINE (1966– August 2009), International Pharmaceutical Abstracts (1970–August 2009), and Cochrane Database of Systematic Reviews (until third quarter 2009) to locate clinical trials and meta-analyses comparing β-blocker therapy with placebo or other antihypertensive agents in patients with hypertension. Bibliographies from relevant research and review articles were reviewed for additional references. STUDY SELECTION AND DATA EXTRACTION: All English-language articles identified from the data sources were reviewed. Articles describing original research with cardiovascular or cerebrovascular outcomes and/or death as either primary or secondary endpoints were included. Articles describing the use of β-blocker therapy for conditions other than hypertension were not included. DATA SYNTHESIS: Five placebo-controlled studies and 10 active-controlled studies were reviewed. In addition, 11 meta-analyses were evaluated. Placebo-controlled trials of β-blockers in hypertension provide evidence of reduced risk for stroke, cardiovascular events, and heart failure. Only 2 studies comparing β-blockers with other antihypertensives found significant benefit with β-blockers. However, the majority of meta-analyses comparing β-blockers with other antihypertensive agents show increased risk for stroke with β-blockers, and some data suggest increased risk for cardiovascular events and all-cause mortality. The majority of data results from studies of atenolol, and many studies employed combination antihypertensive therapies, which often included thiazide diuretics. CONCLUSIONS: Overall, data supporting β-blockers as preferred therapy in hyper- tension are inadequate. Although most negative cardiovascular and cere- brovascular outcomes of β-blockers were associated with atenolol therapy, data supporting other β-blockers in hypertension are lacking. KEY WORDS: antihypertensive therapy, β-blocker, blood pressure, β-receptor antagonist, hypertension. Ann Pharmacother 2009;43:2031-43. Published Online, 24 Nov 2009, theannals.com, DOI 10.1345/aph.1M381 A For Our Patients summary of this article is available at ForOurPatients.info by guest on October 11, 2013 aop.sagepub.com Downloaded from by guest on October 11, 2013 aop.sagepub.com Downloaded from by guest on October 11, 2013 aop.sagepub.com Downloaded from by guest on October 11, 2013 aop.sagepub.com Downloaded from by guest on October 11, 2013 aop.sagepub.com Downloaded from by guest on October 11, 2013 aop.sagepub.com Downloaded from by guest on October 11, 2013 aop.sagepub.com Downloaded from by guest on October 11, 2013 aop.sagepub.com Downloaded from by guest on October 11, 2013 aop.sagepub.com Downloaded from by guest on October 11, 2013 aop.sagepub.com Downloaded from by guest on October 11, 2013 aop.sagepub.com Downloaded from by guest on October 11, 2013 aop.sagepub.com Downloaded from by guest on October 11, 2013 aop.sagepub.com Downloaded from