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β-Blockers and Progression of Coronary Atherosclerosis
Ilke Sipahi, MD, and
Steven E. Nissen, MD
4 March 2008 | Volume 148 Issue 5 | Pages 404-405
IN RESPONSE:
Dr. Dunaway's statement that "[p]rospective studies have shown no decreased incidence of myocardial infarction (MI) and stroke in patients treated with β-blockers versus placebo" is not true. The meta-analyses by Lindholm and colleagues (1) and Bradley and colleagues (2), involving more than 20 000 patients with hypertension, showed that β-blockers statistically significantly reduced the incidence of stroke by 19% compared with placebo (95% CI for relative risk, 0.71 to 0.93). Although a non–statistically significant reduction in incidence of MI occurred in these meta-analyses (CI for relative risk, 0.83 to 1.05), β-blockers statistically significantly reduced the incidence of MI by 28% to 41% in patients with a history of MI (3, 4). Recently, it has been recommended that β-blockers not be preferred over other antihypertensives as first-line agents in primary prevention. However, we stated that " ... our analysis involved only patients with established coronary artery disease. Therefore, no conclusion about the effects of β-blocker use can be drawn for primary prevention (for example, hypertensive patients without coronary artery disease)." This statement limits the implications of our study to secondary prevention.
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Author and Article Information
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From the Cleveland Clinic, Cleveland, OH 44195.
Potential Financial Conflicts of Interest: Dr. Sipahi has received an educational grant from Pfizer and lecture honoraria from AstraZeneca. Dr. Nissen has received research support from AstraZeneca, Eli Lilly, Pfizer, Takeda, Sankyo, and Sanofi-Aventis. Dr. Sipahi has also consulted for many pharmaceutical companies without financial compensation. All honoraria, consulting fees, or other payments from any for-profit entity are paid directly to charity so that no income or tax deduction is received.
1. Lindholm LH, Carlberg B, Samuelsson O. Should beta blockers remain first choice in the treatment of primary hypertension? A meta-analysis. Lancet. 2005;366:1545-53. [PMID: 16257341].[Medline]
2. Bradley HA, Wiysonge CS, Volmink JA, Mayosi BM, Opie LH. How strong is the evidence for use of beta-blockers as first-line therapy for hypertension? Systematic review and meta-analysis. J Hypertens. 2006;24:2131-41. [PMID: 17053529].[Medline]
3. Timolol-induced reduction in mortality and reinfarction in patients surviving acute myocardial infarction. N Engl J Med. 1981;304:801-7. [PMID: 7010157].[Abstract]
4. Julian DG, Prescott RJ, Jackson FS, Szekely P. Controlled trial of sotalol for one year after myocardial infarction. Lancet. 1982;1:1142-7. [PMID: 6122937].[Medline]
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