Third-generation beta-blockers such as carvedilol and nebivolol are less effective than other antihypertensive medications when it comes to the first-line treatment of hypertension, according to a new study published in Hypertension.
Recent research has suggested that beta-blockers are inferior to other treatment options such as angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers and thiazide diuretics (TDs). However, those studies largely focused on second-generation beta-blockers such as atenolol. The study’s authors wondered if third-generation beta-blockers may perform better—and they aimed to find out.
“Theoretically, third-generation beta-blockers with vasodilating properties, such as nebivolol and carvedilol, may have more favorable efficacy compared with second-generation beta-blockers in reducing cardiovascular events,” wrote lead author Seng Chan You, MD, of the department of biomedical informatics at Ajou University School of Medicine in Korea, and colleagues. “Nonetheless, evidence for the effectiveness and safety of third-generation beta-blockers for treating hypertension in comparison with atenolol and with other classes of antihypertensive medications is lacking, especially regarding clinical outcomes.”
The team evaluated data from more than 386,000 U.S. patients who received care from 2001 to 2018. Data was taken from three different datasets. While more than 118,000 patients received first-line treatment with carvedilol or nebivolol, more than 267,000 were given atenolol.
Overall, when it came to the risk of acute myocardial infarction, stroke or heart failure hospitalization, the team found no significant differences between patients treated with carvedilol or nebivolol and patients treated with atenolol. The third-generation beta-blockers were associated with a higher risk of stroke than ACE inhibitors and TDs.
These findings, the authors wrote, support recent moves by the American College of Cardiology and American Heart Association to no longer recommend beta-blockers as a first-line therapy option for hypertension.
“Nonetheless, further study is warranted given the potential for residual confounding and the short duration of medication,” they concluded.
Read the full analysis here.