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Review: available evidence does not support the use of β blockers as first line treatment for hypertension

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 Q In adults with hypertension, what is the effectiveness and safety of β blockers (BBs)?

Clinical impact ratings GP/FP/Primary care ★★★★★★★ IM/Ambulatory care ★★★★★★☆ Nephrology ★★★★★★☆ Cardiology ★★★★★☆☆


Embedded ImageData sources:

PubMed, EMBASE/Excerpta Medica, Cochrane Database of Systematic Reviews, Cochrane Register of Controlled Trials, York Database of Abstracts and Reviews of Effectiveness, reference lists, experts in the field, and drug manufacturers.

Embedded ImageStudy selection and assessment:

randomised controlled trials (RCTs) that evaluated BBs in adults with hypertension. Study methods were assessed for quality, including allocation concealment, blinding, and completeness of follow up. 13 RCTs (91 561 patients) met the selection criteria.

Embedded ImageOutcomes:

total mortality. Secondary outcomes included coronary heart disease, cardiovascular disease, stroke, and adverse drug reactions.


BBs do not reduce mortality (table) or coronary heart disease (see table at more than placebo, diuretics, or renin angiotensin system …

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  • For correspondence: Dr C S Wiysonge, Ministry of Public Health, Yaoundé, Cameroon. wiysonge{at}

  • Source of funding: Medical Research Council (CSW) South Africa.