Calcium channel blockers as first-line treatment for hypertension are associated with a lower risk of death and cardiovascular disease than beta-blockers, according to an analysis in Issue 1 2007 of the Cochrane Database of Systematic Reviews.

The current review follows several similar reviews that found beta-blocker users have a slightly higher risk of death and cardiovascular disease than patients who use calcium channel blockers. The current study also found that patients who were given diuretics or angiotensin receptor inhibitors as first-line treatment had risks similar to those of patients given beta-blockers.

Dr. Charles Shey Wiysonge of the Ministry of Public Health in Cameroon, who led the new review, said many recent reviews “arrived at similar conclusions - that the available evidence does not support the use of beta-blockers as first-line drugs in the treatment of hypertension.”

The current review differed from other recent reviews because it compared beta-blockers head-to-head against specific antihypertensive medications rather than comparing beta-blockers against all other hypertension medicines as a group.

After reviewing 13 studies involving 91,561 patients, Wiysonge and colleagues found no difference in the risk of death or cardiovascular disease among those who used beta-blockers, diuretics and angiotensin receptor inhibitor drugs.
However, the absolute risk of death was a half percent greater among beta-blocker users than among calcium channel blocker users.

In addition, patients taking beta-blockers had a 1.3 percent increase in the risk of cardiovascular disease - mostly strokes - compared with those taking calcium channel blockers.

Also, “patients who used beta-blockers were more likely to experience undesirable effects and abandon their antihypertension medications” compared with patients who took diuretics or angiotensin receptor inhibitors, Wiysonge said.