A meta-analysis of randomized controlled trials assessing the impact of beta-blockers on arterial stiffness, peripheral blood pressure and heart rate

BackgroundThe recognition of beta-blockers as a preferred initial therapy for hypertension has been a hot topic of debate recently. This meta-analysis was aimed to assess the impact of different beta-blockers on arterial stiffness as indexed by pulse wave velocity (PWV), peripheral blood pressure (BP) and heart rate, relative to the placebo, angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs).MethodsTwo authors independently searched articles, appraised eligibility and abstracted information, and the data were analyzed using STATA.ResultsTwenty-four articles involving 27 independent trials were eligible. Relative to the placebo, treatment with beta-blockers led to remarkable improvement in PWV (WMD, 95% CI, P: − 1.115 m/s, − 1.561 to − 0.669, < 0.001), systolic BP (− 12.355 mmHg, − 14.330 to − 10.380, < 0.001), diastolic BP (− 8.619 mmHg, − 10.357 to − 6.880, < 0.001), mean BP (− 9.683 mmHg, − 11.172 to − 8.194, < 0.001), pulse pressure (− 4.448 mmHg, − 7.386 to − 1.510, 0.003) and heart rate (− 12.335, − 22.739 to − 1.932, 0.020). Beta-blockers were remarkably superior to ACEIs in DBP (− 2.540 mmHg, − 4.463 to − 0.617, 0.010) and heart rate (− 9.859 bpm, − 11.752 to − 7.969, < 0.001). In contrast to ARBs, beta-blocker treatment increased systolic BP (2.042 mmHg, 0.639 to 3.444, 0.004) but reduced heart rate (− 8.814 bpm, − 9.756 to − 7.873, < 0.001) significantly. No publication bias was observed.ConclusionsBeta-blockers exerted more favorable impact than the placebo on arterial stiffness, peripheral BP and heart rate, but less favorable impact than ACEIs or ARBs on all, except heart rate, characters, especially in trials with longer duration of treatment and higher baseline PWV.