Messerli Franz H, Bangalore Sripal, Mandrola John M
Faculty of Medicine, University of Bern, Bern, Switzerland.
Leon H Charney Division of Cardiology, New York University School of Medicine, New York, NY, USA.
Lancet. 2023 Nov 11;402(10414):1802-1804. doi: 10.1016/S0140-6736(23)01733-6. Epub 2023 Oct 13.
In their recent guidelines, the European Society of Hypertension upgraded β blockers, putting them on equal footing with thiazide diuretics, renin-angiotensin system blockers (eg, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers), and calcium channel blockers. The reason offered for upgrading β blockers was the observation that they are often used for many other clinical conditions commonly encountered with hypertension. This upgrade would allow for the treatment of two conditions with a single drug (a so-called twofer). In most current national and international hypertension guidelines, β blockers are only considered to be an alternative when there are specific indications. Compared with the other first-line antihypertensive drug classes, β blockers are significantly less effective in preventing stroke and cardiovascular mortality. To relegate β blockers to an inferiority status as previous guidelines have done was based on the evidence in aggregate, and still stands. No new evidence supports the switch of β blockers back to first-line therapy. We are concerned that this move might lead to widespread harm because of inferior stroke protection.
在其最新指南中，欧洲高血压学会提升了β受体阻滞剂的地位，使其与噻嗪类利尿剂、肾素 - 血管紧张素系统阻滞剂（如血管紧张素转换酶抑制剂和血管紧张素受体阻滞剂）以及钙通道阻滞剂处于同等地位。提升β受体阻滞剂地位的理由是观察到它们常用于高血压患者常见的许多其他临床情况。这种提升将允许用单一药物治疗两种病症（即所谓的一举两得）。在当前大多数国家和国际高血压指南中，只有在有特定指征时，β受体阻滞剂才被视为一种替代药物。与其他一线抗高血压药物类别相比，β受体阻滞剂在预防中风和心血管死亡方面的效果明显较差。像以前的指南那样将β受体阻滞剂置于次要地位是基于总体证据，且仍然成立。没有新的证据支持将β受体阻滞剂重新列为一线治疗药物。我们担心这一举措可能会因中风预防效果较差而导致广泛危害。
