β-Blocker survival benefit outweighs side-effect risks

ABSTRACT

BACKGROUND: Despite mortality benefits, β-blockers are often underused, possibly because of concerns of developing side effects. The authors systematically reviewed trials with patients receiving β-blockers for myocardial infarction, heart failure, or hypertension that assessed for symptoms of depression, fatigue, and sexual dysfunction.

POPULATION STUDIED: Researchers identified controlled trials completed before December 2001 using a MEDLINE search. Reference lists of published trials were reviewed for additional studies. The authors identified 475 articles that matched keyword searches and found 15 randomized placebo-controlled trials meeting inclusion criteria of enrollment of at least 100 patients with a minimum 6-month follow-up. This evaluation included 6 post-myocardial infarction, 3 heart failure, and 6 hypertension trials totaling more than 35,000 patients.

STUDY DESIGN AND VALIDITY: The authors compared β-blockers with placebo in relation to patient-reported depression, fatigue, and sexual dysfunction, and withdrawal due to these agents. Propranolol and timolol were classified as early-generation drugs and the remaining tested β-blockers classified as late-generation agents. Bucindolol, carvedilol, and propranolol were categorized as highly lipid soluble agents, with the rest as low-to-moderately lipid soluble.

OUTCOMES MEASURED: The main outcomes measured were number of patient-reported symptoms and withdrawal of therapy related to each of the evaluated side effects—depression, fatigue, or sexual dysfunction—compared with placebo.

RESULTS: Seven of the 15 trials evaluated the overall frequency of reported depressive symptoms. Combining the result of these 7 trials identified no difference compared with placebo. Withdrawal of medication attributed to depression was assessed in 4 trials (N = 5800) with an average follow-up of 14 months. No difference was noted between b-blocker therapy and placebo for risk of withdrawal due to depression (relative risk [RR] = 0.94; 95% confidence interval [CI], 0.44–2.01). Early-generation and highly lipid soluble b-blockers were studied in 3 and 5 trials, respectively, with an average follow-up of 16 months. The comparisons for generation and solubility revealed no difference in the incidence of depression.

ABSTRACT

BACKGROUND: Despite mortality benefits, β-blockers are often underused, possibly because of concerns of developing side effects. The authors systematically reviewed trials with patients receiving β-blockers for myocardial infarction, heart failure, or hypertension that assessed for symptoms of depression, fatigue, and sexual dysfunction.

POPULATION STUDIED: Researchers identified controlled trials completed before December 2001 using a MEDLINE search. Reference lists of published trials were reviewed for additional studies. The authors identified 475 articles that matched keyword searches and found 15 randomized placebo-controlled trials meeting inclusion criteria of enrollment of at least 100 patients with a minimum 6-month follow-up. This evaluation included 6 post-myocardial infarction, 3 heart failure, and 6 hypertension trials totaling more than 35,000 patients.

STUDY DESIGN AND VALIDITY: The authors compared β-blockers with placebo in relation to patient-reported depression, fatigue, and sexual dysfunction, and withdrawal due to these agents. Propranolol and timolol were classified as early-generation drugs and the remaining tested β-blockers classified as late-generation agents. Bucindolol, carvedilol, and propranolol were categorized as highly lipid soluble agents, with the rest as low-to-moderately lipid soluble.

OUTCOMES MEASURED: The main outcomes measured were number of patient-reported symptoms and withdrawal of therapy related to each of the evaluated side effects—depression, fatigue, or sexual dysfunction—compared with placebo.

RESULTS: Seven of the 15 trials evaluated the overall frequency of reported depressive symptoms. Combining the result of these 7 trials identified no difference compared with placebo. Withdrawal of medication attributed to depression was assessed in 4 trials (N = 5800) with an average follow-up of 14 months. No difference was noted between b-blocker therapy and placebo for risk of withdrawal due to depression (relative risk [RR] = 0.94; 95% confidence interval [CI], 0.44–2.01). Early-generation and highly lipid soluble b-blockers were studied in 3 and 5 trials, respectively, with an average follow-up of 16 months. The comparisons for generation and solubility revealed no difference in the incidence of depression.

ABSTRACT

BACKGROUND: Despite mortality benefits, β-blockers are often underused, possibly because of concerns of developing side effects. The authors systematically reviewed trials with patients receiving β-blockers for myocardial infarction, heart failure, or hypertension that assessed for symptoms of depression, fatigue, and sexual dysfunction.

POPULATION STUDIED: Researchers identified controlled trials completed before December 2001 using a MEDLINE search. Reference lists of published trials were reviewed for additional studies. The authors identified 475 articles that matched keyword searches and found 15 randomized placebo-controlled trials meeting inclusion criteria of enrollment of at least 100 patients with a minimum 6-month follow-up. This evaluation included 6 post-myocardial infarction, 3 heart failure, and 6 hypertension trials totaling more than 35,000 patients.

STUDY DESIGN AND VALIDITY: The authors compared β-blockers with placebo in relation to patient-reported depression, fatigue, and sexual dysfunction, and withdrawal due to these agents. Propranolol and timolol were classified as early-generation drugs and the remaining tested β-blockers classified as late-generation agents. Bucindolol, carvedilol, and propranolol were categorized as highly lipid soluble agents, with the rest as low-to-moderately lipid soluble.

OUTCOMES MEASURED: The main outcomes measured were number of patient-reported symptoms and withdrawal of therapy related to each of the evaluated side effects—depression, fatigue, or sexual dysfunction—compared with placebo.

RESULTS: Seven of the 15 trials evaluated the overall frequency of reported depressive symptoms. Combining the result of these 7 trials identified no difference compared with placebo. Withdrawal of medication attributed to depression was assessed in 4 trials (N = 5800) with an average follow-up of 14 months. No difference was noted between b-blocker therapy and placebo for risk of withdrawal due to depression (relative risk [RR] = 0.94; 95% confidence interval [CI], 0.44–2.01). Early-generation and highly lipid soluble b-blockers were studied in 3 and 5 trials, respectively, with an average follow-up of 16 months. The comparisons for generation and solubility revealed no difference in the incidence of depression.