Beta-blockers as first antihypertensives tied to more cardiac events

Initiating antihypertensive treatment with an angiotensin-converting enzyme inhibitor (ACEI), an angiotensin receptor blocker (ARB), or a calcium channel blocker (CCB) results in a comparable risk for myocardial infarction (MI), acute coronary syndrome (ACS), heart failure (HF), or stroke when compared with thiazides, reports a study. On the other hand, use of beta-blockers (BBs) tends to increase such risk.

Overall, 97,639 patients started treatment for hypertension with a single drug as first-line therapy. ACEIs/ARBs were the most prescribed medication (n=66,717, 68.3 percent), followed by CCBs (n=15,922, 16.3 percent), BBs (n=12,869, 13.2 percent), and thiazides (n=2,131, 2.2 percent).

The estimated risks for the primary composite outcome of first occurrence of MI, ACS, HF, or stroke were as follows: BB (hazard ratio [HR], 1.44, 95 percent confidence interval [CI], 1.25‒1.66), CCB (HR, 1.10, 95 percent CI, 0.96‒1.27), and ACEI/ARB (HR, 1.13, 95 percent CI, 0.99‒1.29) relative to thiazides.

This nationwide retrospective new-user cohort study included patients with a new diagnosis of hypertension between 2008 and 2021 who initiated treatment with a single first-line drug for hypertension. The authors then assessed the primary composite outcomes with and without propensity score matching for confounding factors.

“The best first-line monotherapy for hypertension remains uncertain, as current guidelines suggest that thiazides, ACEIs, ARBs, and CCBs are appropriate in the absence of specific comorbidities,” according to the authors.