Department of Primary Care and Mental Health, University of Liverpool.
Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool.
J Hypertens. 2024 Jun 1;42(6):948-950. doi: 10.1097/HJH.0000000000003733. Epub 2024 Apr 12.
Originally, the beta-blockers were equally ranked alongside the other antihypertensive drug classes. Things changed when two major long-term randomized controlled trials, ASCOT-BPLA and LIFE showed that the patients receiving the beta-blockers based regimes suffered 25-30% more strokes than those receiving a calcium channel blocker based regime or an angiotensin receptor blocker based regime. The inferiority of the beta-blockers at stroke prevention was not due to differences in blood pressure control during the follow-up period in both trials. The 2023 European Society of Hypertension (ESH) guidelines still argue in favour of beta-blockers that their clinical inferiority was simply to lesser blood pressure reduction rather than class effect. The analysis argues that the return of beta-blockers as a first-line option for the management of uncomplicated hypertension by the ESH is a cause for concern and should be reconsidered.
最初，β受体阻滞剂与其他降压药物类别处于同等地位。当两项主要的长期随机对照试验 ASCOT-BPLA 和 LIFE 表明，接受基于β受体阻滞剂的治疗方案的患者比接受基于钙通道阻滞剂或血管紧张素受体阻滞剂的治疗方案的患者发生中风的风险高出 25-30%时，情况发生了变化。在这两项试验中，β受体阻滞剂在预防中风方面的劣势并非由于随访期间血压控制的差异所致。2023 年欧洲高血压学会 (ESH) 指南仍主张β受体阻滞剂，认为其临床劣势仅仅是降压效果较差，而不是类效应。该分析认为，ESH 将β受体阻滞剂重新作为治疗单纯性高血压的一线选择是令人担忧的，应该重新考虑。
