Recent Trials in Hypertension

Abstract

95% CI, 0.44-0.76), and total mortality (RR, 0.90; 95% CI, 0.81-0.99). Compared with placebo, -blockers— primarily atenolol, which had been used in many of the trials—wereassociatedwithreducedrisksofstroke(RR,0.71; 95%CI,0.59-0.86)andheartfailure(RR,0.58;95%CI,0.400.84) but not of coronary heart disease (RR, 0.93; 95% CI, 0.80-1.09) or total mortality (RR, 0.95; 95% CI, 0.841.07). 4 The results of recent meta-analyses by Carlberg et al 5 andLindholmetal 6 haveconfirmedthese-blockerfindings, although heart failure was omitted as an outcome of interest. 6 The importance of -blocker therapy in patients with heart failure was also clearly defined in the 1990s. 7 For -blocker therapy, an unanticipated finding was the disparity between its clear mortality benefit in the treatment of patients with coronary heart disease regardless of hypertension status 8 and its apparent inability to prevent coronaryheartdiseaseinthetreatmentofpatientswithhigh blood pressure. In the meta-analyses of placebo-controlled trials in hypertension, 4-6 the reductions in coronary heart disease risk associated with -blockers have been modest, with 95% CIs that include 1.0. Severalexplanationsarepossible.Inlow-riskasymptomatic populations receiving -blockers for hypertension, a withdrawal syndrome precipitating coronary syndromes in