Several meta-analyses have concluded that efficacy of ОІ-blockers in hypertension is inferior compared with other classes of antihypertensive drugs: ACE (angiotensin-converting enzyme) inhibitors, angiotensin receptor blockers (ARBs), calcium-channel blockers (CCBs), and thiazide or thiazide-like diuretics (TDs). 2, 3 However, Messerli et al 4, 5 raised concerns about this preference due to paucity of the evidence for ОІ-blockers to reduce morbidity or mortality in patients with uncomplicated hypertension.

1 Historically, ОІ-blockers had been recommended as one of the first-line treatment options for primary hypertension by the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure from its first report in 1977 through its seventh report in 2003. О’-Blockers have been a mainstay for antihypertensive treatment over the past half a century. Patients on third-generation ОІ-blockers had a higher risk of stroke than those on ACE inhibitors and thiazide diuretics. In conclusion, this study found many patients with first-line ОІ-blocker monotherapy for hypertension and no statistically significant differences in the effectiveness and safety comparing atenolol with third-generation ОІ-blockers. Third-generation ОІ-blockers were associated with significantly higher risk of stroke than ACE (angiotensin-converting enzyme) inhibitors (HR, 1.29 ) and thiazide diuretics (HR, 1.56 ). The pooled hazard ratios (HRs) of acute myocardial infarction, stroke, hospitalization for heart failure, and most metabolic complications were not different between the third-generation ОІ-blockers versus atenolol after propensity score matching and empirical calibration (HR, 1.07 for acute myocardial infarction HR, 1.06 for stroke HR, 1.46 for hospitalized heart failure). Overall, 118вЂ‰133 and 267вЂ‰891 patients initiated third-generation ОІ-blockers (carvedilol and nebivolol) or atenolol, respectively. Estimates were combined across databases using random-effects meta-analyses. In each database, comparative effectiveness of ОІ-blockers for the risks of acute myocardial infarction, stroke, and hospitalization for heart failure was assessed, using large-scale propensity adjustment and empirical calibration. We assessed the effectiveness and safety of ОІ-blockers as first-line treatment for hypertension using 3 databases in the United States: 2 administrative claims databases and 1 electronic health recordвЂ“based database from 2001 to 2018.

Customer Service and Ordering InformationД®vidence for the effectiveness and safety of the third-generation ОІ-blockers other than atenolol in hypertension remains scarce.

Stroke: Vascular and Interventional Neurology.

Journal of the American Heart Association (JAHA).

Circ: Cardiovascular Quality & Outcomes.

Arteriosclerosis, Thrombosis, and Vascular Biology (ATVB).

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