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Independents' Day

ß-blocker row reignites

By Daniel Cressey

Hypertension comes under the spotight at British Cardiovascular Society conference

Experts are demanding ß-blockers be reinstated as a first-line treatment for hypertension, in a move that has split the cardiology profession.

The 'bring back ß-blockers' movement carried half the audience in a specially arranged debate at last week's British Cardiovascular Society conference in Glasgow.Some doctors have been unhappy since NICE relegated ß-blockers to second-line therapy last year, arguing the drugs remain useful, particularly for younger patients.Europe still endorses ß-blockers as first-line treatment, prompting the debate over whether the UK is ahead of the curve or misguided.Professor Gordon McInnes, professor of clinical pharmacology at the University of Glasgow, told the conference: 'We've come to realise that "it's the blood pressure, stupid", not the drug you use. This is against a background of sleaze – ß-blockers have few patents, few profits and few friends. ß-blockers should be restored as a first-line option in younger, uncomplicated hypertension.'Professor McInnes claimed key studies used to downgrade ß-blockers were seriously flawed, singling out a Lancet meta-analysis, which he claimed had a p value for heterogeneity far above that which should be acceptable.Others strongly disagreed. Professor Gareth Beevers, professor of medicine at the University of Birmingham, said: 'ß-blockers are not very effective in the elderly – the majority of our patients. They have no place in the management of uncomplicated hypertension.'A survey for Pulse with doctors' mobile communications firm Pearl Medical found GPs had moved away from ß-blocker use, with 72% saying they had changed their practice since publication of NICE hypertension guidelines.Dr Rubin Minhas, a GP in GiIlingham, Kent, and CHD lead for Medway PCT, said: 'I would support current guidelines, while recognising there is variation in the drugs' effectiveness. Some groups such as younger people may benefit.'

Should β-blockers be first line treatment?

* Safe and effective
* Particularly useful in the young, and those with AF and other comorbidities
* Meta-analyses suggesting they are less effective than other drugs are flawed
* ASCOT trial used atenolol – known to be less effective than other ß-blockers
* Less effective than other hypertensive drugs, particularly in elderly
* Raise the risk of stroke
* May cause type 2 diabetes

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