Efficacy of beta-blockers on blood pressure control and morbidity and mortality endpoints in hypertensives of African ancestry: an individual patient data meta-analysis.

Pubmed ID: 38322274

Pubmed Central ID: PMC10844441

Journal: Frontiers in cardiovascular medicine

Publication Date: Jan. 23, 2024

Authors: Tsabedze N, Naicker RD, Mrabeti S

Cite As: Tsabedze N, Naicker RD, Mrabeti S. Efficacy of beta-blockers on blood pressure control and morbidity and mortality endpoints in hypertensives of African ancestry: an individual patient data meta-analysis. Front Cardiovasc Med 2024 Jan 23;10:1280953. doi: 10.3389/fcvm.2023.1280953. eCollection 2023.

Studies:

Abstract

INTRODUCTION: Compared with first-line antihypertensives, beta-blockers (BB) have been reported to lower the central aortic blood pressure suboptimally and are associated with increased stroke risk. This observation has not been investigated in hypertensives of African ancestry. We hypothesised that an individual patient data meta-analysis (IPD-MA) on the efficacy of second- or third-generation beta-blockers (STGBBs) in hypertensives of African descent may provide new insights. METHODS: A single-stage IPD-MA analysed the efficacy of STGBB in lowering the mean arterial blood pressure and reducing the composite outcomes: cardiovascular death, stroke, and myocardial infarction. RESULTS: A total of 11,860 participants from four randomised control trials were included in the analysis. Second- or third-generation beta-blockers reduced the mean arterial pressure by 1.75 mmHg [95% confidence interval (CI):1.16-2.33; <i>P</i> &lt; 0.001] in all participants included in the analysis, and by 1.93 mmHg (95% CI: 0.86-3.00; <i>P</i> &lt; 0.001) in hypertensive Africans. In patients with established cardiovascular disease, where the benefits of BB therapy are well established, STGBBs were associated with an adjusted odds ratio of 1.33 (95% CI: 1.06-1.65; <i>P</i> = 0.015) of the composite outcome, most likely due to confounding. Similarly, the risk of total myocardial infarction was 1.76 times higher (95% CI: 1.15-2.68; <i>P</i> = 0.008) in hypertensives of African ancestry on STGBBs. CONCLUSION: The STGBBs reduced the mean arterial pressure comparably to other antihypertensives, and they were not associated with an increased risk of stroke.