Archief Roodbont

October 24, 2008 — Slowing the heart rate with beta blockers in people with hypertension is associated with an increased risk of cardiovascular events and death, a new systematic review shows [1]. Furthermore, the slower the heart rate, the greater the risk, report Dr Sripal Bangalore (St Luke's Roosevelt Hospital, New York) and colleagues in the October 28, 2008, issue of the Journal of the American College of Cardiology.

Senior author Dr Franz Messerli (St Luke's Roosevelt Hospital) told heartwire: "Slowing heart rate is known to prolong life expectancy, and with beta blockers post-MI [myocardial infarction] and in heart failure, the slower you can make the heart rate, the better. But this new paper goes against the grain. What we show is that in hypertension, when you slow down the heart rate with a beta blocker, it actually shortens your life expectancy, it causes more heart attacks, more heart failure, and more strokes." Messerli says he and his team believe the likely explanation for this is "that slowing the heart rate with beta blockers increases the central pressure, and obviously the latter is one of the determinants of stroke and heart attack."

Another hypertension expert sees things slightly differently, however. Dr John Cockcroft (Wales Heart Institute, Cardiff, UK) argues that in this review, the studies included almost exclusively used atenolol — something the authors do point out — and that it is this drug per se that is likely the culprit here.

What is vitally important to determine in this setting, he adds, "is whether it's atenolol that's bad or whether it's reduction of heart rate that's bad." This is crucial because there are other drugs that aren't beta blockers that lower heart rate, he explained, such as the new agent ivabradine (Procoralan, Servier). "This issue needs resolving because if it's heart-rate reduction [that is the cause], then that's bad news, and we need to know about it.

# posted by roodbont @ 3:32 AM