Saturday, April 07, 2007
Beta blockers
Beta blockers over-used in elderly with uncomplicated hypertension
2 April 2007
Elderly patients with uncomplicated hypertension are too often prescribed beta blockers as first-line therapy, according to a study of patients in Ontario, Canada.
Beta blockers were prescribed as initial therapy to one in 10 such patients who did not have any other compelling indication for beta blocker use, such as heart failure, myocardial infarction (MI), or angina, over the period 1994-2002.
This occurred despite explicit recommendations not to use the drugs as initial therapy being in place over the entire period, N Campbell (University of Calgary, Toronto, Canada) and colleagues note.
Large randomized controlled trials and meta-analyses have shown that beta blockers are less effective for the prevention of cardiovascular events in elderly hypertensive patients than diuretics, angiotensin receptor blockers, and calcium channel blockers, Campbell and colleagues explain in the Journal of Human Hypertension.
The researchers studied the prevalence of prescribing beta blockers as initial therapy in Ontario residents aged 66 years or older who received a new prescription for an antihypertensive agent between July 1994 and March 2002.
The researchers excluded patients who had a comorbid indication for a beta blocker. Of 194,761 eligible patients, 25,485 (13%) were prescribed a beta-blocker as their first antihypertensive therapy.
By looking at the annual population-adjusted prescribing rates, the authors found that there was a 27% increase in beta blocker prescriptions for newly treated hypertension over the study period. The publication in 1998 of a large meta-analysis showing beta blockers to be less effective in the elderly than other antihypertensive agents appeared to have no impact on this trend.
Initiation with a beta blocker became less common with increasing age. For example, the prescribing rate was 14% among 66-69-year-olds versus 10% of patients aged 85 years or more, with an odds ratio (OR) of 1.67.
Other factors associated with being prescribed a beta blocker included being male (OR=1.06 vs women), residence in a long-term care facility (OR=1.19 vs living in the community), and having lower socioeconomic statue (OR=1.07 for lowest vs highest quintile).
"Greater efforts are required to educate physicians to select other drugs for initial therapy in older patients with uncomplicated hypertension," the authors conclude.
In an accompanying editorial, S Bangalore and F Messerli (Columbia University, New York, USA) commented that the study is "an eye opener for those of us who were under the impression that beta blocker prescriptions in elderly hypertensive patients had diminished."
They noted that some other national and international guidelines continued their endorsement for beta blocker use in hypertension during the study period, and high-profile studies regarding their benefits in MI patients and those undergoing non-cardiac surgery were published.
"It is therefore not surprising that physicians in Canada and elsewhere continued prescribing beta blockers for hypertension," they wrote.
"Efforts should be made to educate the people, physicians and the guideline committee."
J Hum Hypertens 2007; 21: 271-275
2 April 2007
Elderly patients with uncomplicated hypertension are too often prescribed beta blockers as first-line therapy, according to a study of patients in Ontario, Canada.
Beta blockers were prescribed as initial therapy to one in 10 such patients who did not have any other compelling indication for beta blocker use, such as heart failure, myocardial infarction (MI), or angina, over the period 1994-2002.
This occurred despite explicit recommendations not to use the drugs as initial therapy being in place over the entire period, N Campbell (University of Calgary, Toronto, Canada) and colleagues note.
Large randomized controlled trials and meta-analyses have shown that beta blockers are less effective for the prevention of cardiovascular events in elderly hypertensive patients than diuretics, angiotensin receptor blockers, and calcium channel blockers, Campbell and colleagues explain in the Journal of Human Hypertension.
The researchers studied the prevalence of prescribing beta blockers as initial therapy in Ontario residents aged 66 years or older who received a new prescription for an antihypertensive agent between July 1994 and March 2002.
The researchers excluded patients who had a comorbid indication for a beta blocker. Of 194,761 eligible patients, 25,485 (13%) were prescribed a beta-blocker as their first antihypertensive therapy.
By looking at the annual population-adjusted prescribing rates, the authors found that there was a 27% increase in beta blocker prescriptions for newly treated hypertension over the study period. The publication in 1998 of a large meta-analysis showing beta blockers to be less effective in the elderly than other antihypertensive agents appeared to have no impact on this trend.
Initiation with a beta blocker became less common with increasing age. For example, the prescribing rate was 14% among 66-69-year-olds versus 10% of patients aged 85 years or more, with an odds ratio (OR) of 1.67.
Other factors associated with being prescribed a beta blocker included being male (OR=1.06 vs women), residence in a long-term care facility (OR=1.19 vs living in the community), and having lower socioeconomic statue (OR=1.07 for lowest vs highest quintile).
"Greater efforts are required to educate physicians to select other drugs for initial therapy in older patients with uncomplicated hypertension," the authors conclude.
In an accompanying editorial, S Bangalore and F Messerli (Columbia University, New York, USA) commented that the study is "an eye opener for those of us who were under the impression that beta blocker prescriptions in elderly hypertensive patients had diminished."
They noted that some other national and international guidelines continued their endorsement for beta blocker use in hypertension during the study period, and high-profile studies regarding their benefits in MI patients and those undergoing non-cardiac surgery were published.
"It is therefore not surprising that physicians in Canada and elsewhere continued prescribing beta blockers for hypertension," they wrote.
"Efforts should be made to educate the people, physicians and the guideline committee."
J Hum Hypertens 2007; 21: 271-275
# posted by roodbont @ 12:21 PM 
