Blood pressure lowering effects of β-blockers as add-on or combination therapy: A meta-analysis of randomized controlled trials

Abstract

The authors performed a meta-analysis to assess the efficacy of non-atenolol β-blockers as add-on to monotherapy or as a component of combination antihypertensive therapy in patients with hypertension. The authors searched and identified relevant randomized controlled trials from PubMed until November 2021. Studies comparing blood pressure lowering effects of β-blockers with diuretics, calcium channel blockers (CCBs), angiotensin-converting enzyme inhibitors (ACEIs), or angiotensin receptor blockers (ARBs) were included. The analysis included 20 studies with 5544 participants. β-blockers add-on to monotherapy significantly reduced systolic and diastolic blood pressure as compared with non-β-blocker monotherapy (weighted mean difference in mm Hg [95% confidence interval]: −4.1 [−6.0, −2.2] and −3.7 [−4.6, −2.8], respectively). These results were consistent across the comparisons with diuretics (systolic pressure, −10.2 [−14.2, −6.2]; diastolic pressure, −5.4 [−8.2, −2.6]), CCBs (systolic pressure, −4.1 [−7.1, −1.0]; diastolic pressure, −2.8 [−4.1, −1.5]), and ACEIs/ARBs (systolic pressure, −2.9 [−4.3, −1.5]; diastolic pressure, −4.2 [−5.0, −3.4]). There was no significant difference in blood pressure lowering effects between combinations with and without a β-blocker (systolic pressure, −1.3 mm Hg [−5.8, 3.2]; diastolic pressure, −.3 mm Hg [−2.7, 2.1]). Metoprolol add-on or combination therapy had a significantly greater blood pressure reduction than non-β-blocker therapy (systolic pressure, −3.6 mm Hg [−5.9, −1.3]; diastolic pressure, −2.1 mm Hg [−3.5, −.7]). In conclusion, non-atenolol β-blockers are effective in lowering blood pressure as add-on to monotherapy or as a component of combination antihypertensive therapy. In line with the current hypertension guideline recommendations, β-blockers can and should be used in combination with other antihypertensive drugs.