Posted by: Chris Maloney | September 16, 2013

Are You Still Taking A Beta-Blocker For Blood Pressure? Why You Shouldn’t.

AV-Block III° bei Hinterwandinfarkt: P-Wellen ...

AV-Block III° bei Hinterwandinfarkt: P-Wellen (rot) und QRS-Komplexe (blau) treten unabhängig voneinander auf 3rd degree heart block in a patient with inferior myocardial infarction: complete dissociation of p waves (red) and QRS complexes (blue) (Photo credit: Wikipedia)

As a Naturopathic Doctor, drugs are not my line.  Pretty much if you want drugs you head to your M.D. and D.O.  I see what they’ve got you on, and work around that.  I’ve got a dozen things people can do besides drugs for blood pressure.   I also respect the drugs that others have prescribed.  But there is one set of drugs that has started to really bother me.

Back in 1998, I read in JAMA that beta-blockers as a class should no longer be used as first-line hypertension drugs.  In English that means that things like Atenolol and Metoprolol wouldn’t be given to people as a means of controlling their blood pressure.

The reason that JAMA gave was pretty simple:  “beta-blocker therapy only reduced the odds for cerebrovascular events…but was ineffective in preventing coronary heart disease, cardiovascular mortality, and all-cause mortality” (http://www.ncbi.nlm.nih.gov/pubmed/9634263) In English, beta-blockers lowered strokes but didn’t help heart patients.  Taking diuretics was better for lowering strokes.  So the experts concluded: “beta-blockers, until proven otherwise, should no longer be considered appropriate first-line therapy of uncomplicated hypertension.”  That’s pretty clear.  Beta-blockers aren’t to be given to patients as their first hypertensive drug.

That was 1998.  So we go along and patients are still being given beta-blockers.  They make older people really tired, which I don’t mind if there weren’t better drugs on the market and if they helped older people live longer.  But I figured we’d see a drop-off in prescriptions.

2007 rolls around, and we get another review, this time from the international Cochrane experts.  They concluded: “The available evidence does not support the use of beta-blockers as first-line drugs in the treatment of hypertension.” (http://www.ncbi.nlm.nih.gov/pubmed/17253471) Again, the same conclusion, and I’m wondering where the last nine years have gone.  Are people still taking this stuff, and why isn’t anyone telling the family doctors prescribing beta-blockers that it doesn’t work?

But the rule in medicine is that it takes at least ten years for studies to get out to the clinicians.  So I go on my merry way and spend a lot of time helping older patients who are still on their beta-blockers with their chronic fatigue.

Now it’s 2013, and I look back at 2012 and we have another Cochrane review.  This one says: “Total mortality was not significantly different between beta-blockers and placebo.”  In English that means you die at the same rate if you took beta-blockers or you didn’t.  The reviewer noted that taking beta-blockers does lower stroke risk, and concludes that “The GRADE quality of this evidence is low, implying that the true effect of beta-blockers may be substantially different from the estimate of effects found in this review. Further research should be of high quality” (http://www.ncbi.nlm.nih.gov/pubmed/23152211)

We’ve had the verdict since 1998, we have better drugs on the market that have been available since that time, and I still see older patients handed Metoprolol or Atenolol as the first thing for blood pressure.  The biggest problem is that something I’ve known for fifteen years about a drug hasn’t yet made the rounds of the doctors who prescribe it.  It makes me concerned for patients.

Advertisements

Responses

  1. […] this situation is that I can see all the mud in the backyard of conventional medicine (see last post about beta-blockers).  But I work very hard not to sling mud when I’m with patients because the […]


Tell me what you think!

Please log in using one of these methods to post your comment:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

Categories

%d bloggers like this: