Primary prevention of cardiovascular disease endpoints using beta-blockers

Abstract

To the Editor. —In their meta-analysis of the effect of antihypertensive therapies on preventing disease end points, such as stroke, coronary heart disease, congestive heart failure, and total and cardiovascular mortality, Dr Psaty and colleagues 1 concluded that the data provide strong support for the use of β-blockers and diuretics as first-line agents. However, after a closer look at their data, these conclusions are not supported by the data in the case of β-blockers. When calculating the relative risk associated with β-blocker therapy, the authors used 4 studies: (1) Medical Research Council trial of treatment of mild hypertension (MRC) 2 ; (2) Medical Research Council trial of treatment of hypertension in older adults (MRC-O) 3 ; (3) Swedish Trial in Old Patients With Hypertension (STOP-H) 4 ; and (4) Coope and Warrender. 5 By doing so, they glossed over the fact that in STOP-H, two thirds of the patients in the active treatment