Beta-Blockers Compared for CV Outcomes in Patients with Hypertension

The researchers were able to determine hospitalization risk for composite CV outcomes (myocardial infarction (MI), congestive heart failure (CHF), stroke and angina) as well as risk for individual components.

WASHINGTON, DC—Compared to atenolol and metoprolol, nebivolol monotherapy was associated with reduced cardiovascular-related hospitalization risk, according to a new study presented at the ACC.17 Scientific Session.

Knowing that beta-blockers can lower the risk of cardiovascular (CV) events, the researchers aimed to compare the difference in hospitalization risk between non-vasodilatory β1-blockers (atenolol, metoprolol) and the vasodilatory β1-selective antagonist/β3 agonist, nebivolol.

Using U.S. claims data (2007–2014), the researchers were able to retrospectively identify patients with hypertension taking one of the three medications. Using a pairwise propensity score approach, they were able to match treatment cohorts (n=27,134 each) across the following variables:

  • Baseline demographics
  • Charlson Comorbidity Index score
  • Diabetes
  • Rheumatic, renal and chronic pulmonary diseases
  • Baseline antihypertensive use
  • Treatment duration

Using Cox proportional hazards regression and adjusting for these patient variables, the researchers were able to determine hospitalization risk for composite CV outcomes as well as risk for individual components during the follow-up period in patient newly started on beta-blocker monotherapy. Composite CV event included a primary or secondary diagnosis of any of the individual events: myocardial infarction (MI), congestive heart failure (CHF), stroke, or angina pectoris.

“The follow-up period lasted until discontinuation of the index drug (≥90 day gap in supply), use of non-index beta-blockers, or the end of continuous plan enrollment, whichever came first,” explained lead author, Sanjida Ali, from Temple University School of Medicine, Pittsburgh, PA.

Compared to nebivolol, atenolol and metoprolol patients had a higher risk of hospitalization for composite CV events (68% and 105%, respectively). Patients taking atenolol and metoprolol had higher risks of MI (82% and 78%, respectively) and angina (77% and 174%, respectively) when compared to nebivolol. Moreover, the rate of unadjusted composite CV events (per 1,000 persons per year) were higher with atenolol (7.8) and metoprolol (9.4) vs. nebivolol (4.7).

“In this large retrospective cohort study of hypertensive patients, monotherapy treatment with the beta-blocker nebivolol was associated with lower risk of hospitalization due to CV events vs. either atenolol or metoprolol monotherapy,” Ali concluded.