Vögele Anna, Johansson Tim, Renom-Guiteras Anna, Reeves David, Rieckert Anja, Schlender Lisa, Teichmann Anne-Lisa, Sönnichsen Andreas, Martinez Yolanda V
South Tyrolean Academy of General Practice, via dei Vanga, Bolzano, Italy.
Institute of General Practice and Family Medicine, Paracelsus Medical University, Strubergasse, Salzburg, Austria.
BMC Geriatr. 2017 Oct 16;17(Suppl 1):224. doi: 10.1186/s12877-017-0575-4.
The benefit from a blood pressure lowering therapy with beta blockers may not outweigh its risks, especially in older populations. The aim of this study was to look for evidence on risks and benefits of beta blockers in older adults and to use this evidence to develop recommendations for the electronic decision support tool of the PRIMA-eDS project.
Systematic review of the literature using a stage approach with searches for systematic reviews and meta-analyses first, and individual studies only if the previous searches are inconclusive. The target population were older adults (≥65 years old) with hypertension. We included studies reporting on the effectiveness and/or safety of beta blockers on clinically relevant endpoints (e.g. mortality, cardiovascular events, and stroke) in the management of hypertension. The recommendations were developed according to the GRADE methodology.
Fifteen studies were included, comprising one meta-analysis, four randomized controlled trials, six secondary analyses of randomized controlled trials and four observational studies. Seven studies involved only older adults and eight studies reported subgroup analyses by age. With regard to a composite endpoint (death, stroke or myocardial infarction) beta blockers were associated with a higher risk of events then were other antihypertensive agents. Further, beta blockers showed no benefit compared to other antihypertensive agents or placebo regarding mortality. They appear to be less effective than other antihypertensive agents in reducing cardiovascular events. Contradictory results were found regarding the effect of beta blockers on stroke. None of the studies explored the effect on quality of life, hospitalisation, functional impairment/status, safety endpoints or renal failure.
The quality of current evidence to interpret the benefits of beta blockers in hypertension is rather weak. It cannot be recommended to use beta blockers in older adults as first line agent for hypertension.
β受体阻滞剂降压治疗的获益可能并不大于其风险，尤其是在老年人群中。本研究的目的是寻找β受体阻滞剂在老年人中风险和获益的证据，并利用这些证据为PRIMA-eDS项目的电子决策支持工具制定建议。
采用分阶段方法对文献进行系统评价，首先检索系统评价和荟萃分析，只有在先前检索结果不明确时才检索个体研究。目标人群为≥65岁的老年高血压患者。我们纳入了报告β受体阻滞剂在高血压管理中对临床相关终点（如死亡率、心血管事件和中风）有效性和/或安全性的研究。根据GRADE方法制定建议。
共纳入15项研究，包括1项荟萃分析、4项随机对照试验、6项随机对照试验的二次分析和4项观察性研究。7项研究仅涉及老年人，8项研究报告了按年龄分组的亚组分析。关于复合终点（死亡、中风或心肌梗死），β受体阻滞剂与其他抗高血压药物相比，事件风险更高。此外，与其他抗高血压药物或安慰剂相比，β受体阻滞剂在死亡率方面没有显示出益处。它们在降低心血管事件方面似乎不如其他抗高血压药物有效。关于β受体阻滞剂对中风的影响，发现了相互矛盾的结果。没有研究探讨其对生活质量、住院、功能损害/状态、安全终点或肾衰竭的影响。
目前用于解释β受体阻滞剂在高血压中获益的证据质量相当薄弱。不建议将β受体阻滞剂作为老年高血压患者的一线用药。
