Draw up a good deed
Beta-blockers are set to lose their status as a mainstream treatment for hypertension after two landmark trials threw their use into serious doubt.
The national hypertension treatment guidelines produc-ed by both the British Hypertension Society and NICE are likely to undergo a major overhaul in light of the new evidence.
'The days are numbered for ?-blockers as a preferred first-line therapy for hypertension,' said Professor Bryan Williams, member of both organisations' guidelines committees.
A quarter of all UK patients on mono- or dual therapy for hypertension are on ?-blockers and the numbers affected could run into millions.
The 19,000-patient ASCOT trial was halted this month after finding an ACE inhibitor plus calcium channel blocker had 'substantial benefits' over a ?-blocker plus diuretic.
And the LIFE trial of more than 9,000 patients found the risk of dying from stroke was 35 per cent lower with an ARB than a ?-blocker (see box).
ASCOT leader Professor Peter Sever, a member of the BHS guidelines committee, said ?-blockers were likely to be dropped from the society's ABCD treatment algorithm. 'It almost certainly will take the B out of the ABCD.'
He said the move would not be 'horrendously expensive' as generics would soon be available for all ABCD classes.
Professor Sever, professor of clinical pharmacology and therapeutics at Imperial College London, said: 'I would think the guideline group will sit down with the data early next year. We need to rethink our hypertension treatment strategies using newer more effective treatments.' He is writing to several hundred UK GPs involved in ASCOT to advise them on weaning patients off ?-blockers.
Dr John Pittard, of the Primary Care Cardiovascular Society, advised taking patients from 100mg to 50 and then 25 over a two-week period in line with the BNF. He warned changes to guidelines needed to be user-friendly but ABCD should not be retained 'just because it scans well'.
LIFE researcher Professor Gareth Beevers, professor of medicine at the University of Birmingham, said new guidelines should restrict ?-blockers to patients with CHD or stable heart failure.
Two trials that question ?-blockers' use
Compared perindopril plus amlodipine against atenolol plus bendroflumethiazide in 19,342 hypertensive patients
Stopped a year early after finding 'substantial benefits' on coronary deaths and non-fatal MIs for the perindopril-amlodipine combination
Results will be presented at the American College of Cardiology conference next March
Researchers compared the ARB losartan with atenolol in 9,193 hypertensive patients with left ventricular hypertrophy
Risk of fatal stroke 35 per cent lower in losartan arm
Study published online in Hypertension last week