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Therapeutic efficacy of early intravenous atenolol for acute coronary syndrome: a meta-analysis

Bibliographic details: Cao FF, Zhang HT, Feng X, Jiao RN.  Therapeutic efficacy of early intravenous atenolol for acute coronary syndrome: a meta-analysis. Medical Journal of Chinese People's Liberation Army 2014; 39(1): 35-39 Available from: http://www.plamj.org/index.php/plamj/article/view/868

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

Beta‐blockers for preventing stroke recurrence

People who have had a stroke or a transient ischaemic attack (TIA) are at risk of having further strokes or heart attacks, or other serious circulatory problems. Beta‐blockers are drugs that reduce heart rate and blood pressure, and have other effects that might also reduce the risks of stroke and heart attack. Searching for studies up to May 2014, we found two high quality trials involving 2193 participants that tested beta‐blockers after stroke in people with a recent stroke or TIA. No clear evidence indicated that beta‐blockers reduced the risk of stroke, heart attack, or death from vascular disease. Participants who received beta blockers instead of placebo showed significantly more adverse effects. More studies with larger samples are needed.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Beta blockers for peripheral arterial disease

Intermittent claudication, the most common symptom of atherosclerotic peripheral arterial disease, results from decreased blood flow to the legs during exercise. Beta blockers, a large group of drugs, have been shown to decrease death among people with high blood pressure and coronary artery disease and are used to treat various disorders. They reduce heart activity but can also inhibit relaxation of smooth muscle in blood vessels, bronchi and the gastrointestinal and genitourinary tracts. The non‐selective beta blockers propranolol, timolol and pindolol are effective at all beta‐adrenergic sites in the body, whereas other beta blockers, such as atenolol and metoprolol, are selective for the heart.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Beta‐blockers for hypertension

The aim of this Cochrane Review was to assess whether beta‐blockers decrease the number of deaths, strokes, and heart attacks associated with high blood pressure in adults. We collected and analysed all relevant studies to answer this question and found 13 relevant studies.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2017

Atenolol as a comparator in outcome trials in hypertension: a correct choice in the past, but not for the future?

OBJECTIVE: Twelve years after the design of the Losartan Intervention For Endpoint reduction in hypertension (LIFE) study, which showed superiority of losartan- vs atenolol-based therapy for cardiovascular outcomes, we reviewed the literature for the effect of beta-blockers compared with initial placebo or no treatment on reduction of cardiovascular events to re-evaluate atenolol as the comparator in the LIFE study.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2007

Meta-analysis of carvedilol versus beta 1 selective beta-blockers (atenolol, bisoprolol, metoprolol, and nebivolol).

Because carvedilol is a unique vasodilating β blocker (BB) exerting antioxidant activity and pleiotropic effects, it was theorized that it may confer more potent beneficial effects on cardiovascular mortality and morbidity in acute myocardial infarction (AMI) and heart failure (HF) settings. A systematic review and meta-analysis was performed of randomized, controlled, direct-comparison trials that included adults receiving atenolol, bisoprolol, metoprolol, nebivolol, or carvedilol to evaluate the effects of carvedilol compared to other BBs on mortality, cardiovascular events, and hospital readmissions in the setting of AMI or systolic HF. Compared to β(1)-selective BBs used in HF (8 trials, n = 4,563), carvedilol significantly reduced all-cause mortality (risk ratio 0.85, 95% confidence interval 0.78 to 0.93, p = 0.0006). In 3 trials of patients with AMI (n = 644), carvedilol significantly reduced all-cause mortality by 45% (fixed-effects model: risk ratio 0.55, 95% confidence interval 0.32 to 0.94, p = 0.03, random-effects model: risk ratio 0.56, 95% confidence interval 0.26 to 1.12, p = 0.10), with no reduction in non-fatal MI (risk ratio 0.61, 95% confidence interval 0.31 to 1.22, p = 0.16). In conclusion, carvedilol, as compared against atenolol, bisoprolol, metoprolol and nebivolol in randomized direct comparison trials, significantly reduced all-cause mortality in systolic HF patients. Additionally, carvedilol significantly reduced all-cause mortality compared with β(1)-selective BBs in AMI patients using the fixed-effects model but not using the random-effects model.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Atenolol in hypertension: is it a wise choice?

This review assessed the effect of atenolol on cardiovascular morbidity and mortality in patients with hypertension. The authors concluded that atenolol may not be a suitable treatment option for patients with hypertension, and queried its use as a reference drug in trials. Limitations in the reporting of the review process and the lack of a validity assessment weaken this conclusion.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2004

Tolerability of nebivolol in head-to-head clinical trials versus other cardioselective beta-blockers in the treatment of hypertension: a meta-analysis

Bibliographic details: Ambrosioni E, Borghi C.  Tolerability of nebivolol in head-to-head clinical trials versus other cardioselective beta-blockers in the treatment of hypertension: a meta-analysis. High Blood Pressure and Cardiovascular Prevention 2005; 12(1): 27-35

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2005

Further data on beta-blockers and cancer risk: Observational study and meta-analysis of randomized clinical trials.

BACKGROUND: The aim of the present paper is to provide some further data on the relationship between β-blocker treatment and the incidence of cancer, using two different approaches (epidemiological study and meta-analysis of clinical trials).

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Hypertension: The Clinical Management of Primary Hypertension in Adults: Update of Clinical Guidelines 18 and 34 [Internet]

NICE first issued guidance for the management of hypertension in primary care in 2004. This was followed by a rapid update of the pharmacological treatment chapter of the guideline in 2006. The current partial update of the hypertension guideline is in response to the regular five year review cycle of existing NICE guidance. It began with a scoping exercise which identified key areas of the existing guideline for which new evidence had emerged that was likely to influence or change existing guideline recommendations.

NICE Clinical Guidelines - National Clinical Guideline Centre (UK).

Version: August 2011
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A meta-analysis of 94,492 patients with hypertension treated with beta blockers to determine the risk of new-onset diabetes mellitus

This review concluded that patients receiving β-blockers, in particular those with a higher baseline body mass index and baseline fasting glucose level, have an increased risk of developing new-onset diabetes mellitus and stroke. Overall, the reliability of the findings is unclear given the numerous limitations of the review methods and data, therefore the conclusions should be interpreted with caution.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2007

Dementia: A NICE-SCIE Guideline on Supporting People With Dementia and Their Carers in Health and Social Care

This guideline has been developed to advise on supporting people with dementia and their carers in health and social care. The guideline recommendations have been developed by a multidisciplinary team of health and social care professionals, a person with dementia, carers and guideline methodologists after careful consideration of the best available evidence. It is intended that the guideline will be useful to practitioners and service commissioners in providing and planning high-quality care for those with dementia while also emphasising the importance of the experience of care for people with dementia and carers.

NICE Clinical Guidelines - National Collaborating Centre for Mental Health (UK).

Version: 2007
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Should beta blockers remain first choice in the treatment of primary hypertension: a meta-analysis

This review assessed the use of beta-blockers for treating hypertension. It concluded that beta-blockers lead to an increased risk of stroke compared with other anti-hypertensive drugs and a decreased risk of stroke compared with placebo. Poor reporting of the review process, a limited search, and the lack of a quality assessment make it difficult to assess the reliability of the authors' conclusions.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2005

Hypertension in Pregnancy: The Management of Hypertensive Disorders During Pregnancy

This clinical guideline concerns the management of hypertensive disorders in pregnancy and their complications from preconception to the postnatal period. For the purpose of this guideline, ‘pregnancy’ includes the antenatal, intrapartum and postpartum (6 weeks after birth) periods. The guideline has been developed with the aim of providing guidance in the following areas: information and advice for women who have chronic hypertension and are pregnant or planning to become pregnant; information and advice for women who are pregnant and at increased risk of developing hypertensive disorders of pregnancy; management of pregnancy with chronic hypertension; management of pregnancy in women with gestational hypertension; management of pregnancy for women with pre-eclampsia before admission to critical care level 2 setting; management of pre-eclampsia and its complications in a critical care setting; information, advice and support for women and healthcare professionals after discharge to primary care following a pregnancy complicated by hypertension; care of the fetus during pregnancy complicated by a hypertensive disorder.

NICE Clinical Guidelines - National Collaborating Centre for Women's and Children's Health (UK).

Version: August 2010
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Drug Class Review: Beta Adrenergic Blockers: Final Report Update 4 [Internet]

Beta blockers inhibit the chronotropic, inotropic, and vasoconstrictor responses to the catecholamines, epinephrine, and norepinephrine. Beta blockers differ in their duration of effect (3 hours to 22 hours), the types of beta receptors they block (β1-selective or β1/β2-nonselective), whether they are simultaneously capable of exerting low level heart rate increases (intrinsic sympathomimetic activity [ISA]), and in whether they provide additional blood vessel dilation effects by also blocking alpha-1 receptors. All beta blockers are approved for the treatment of hypertension. Other US Food and Drug Administration-approved uses are specific to each beta blocker and include stable and unstable angina, atrial arrhythmias, bleeding esophageal varices, coronary artery disease, asymptomatic and symptomatic heart failure, migraine, and secondary prevention of post-myocardial infarction. The objective of this review was to evaluate the comparative effectiveness and harms of beta blockers in adult patients with hypertension, angina, coronary artery bypass graft, recent myocardial infarction, heart failure, atrial arrhythmia, migraine or bleeding esophageal varices.

Drug Class Reviews - Oregon Health & Science University.

Version: July 2009
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Stable Angina: Methods, Evidence & Guidance [Internet]

Angina is pain or constricting discomfort that typically occurs in the front of the chest (but may radiate to the neck, shoulders, jaw or arms) and is brought on by physical exertion or emotional stress. It is the main symptomatic manifestation of myocardial ischaemia and is usually caused by obstructive coronary artery disease restricting oxygen delivery to the cardiac myocytes. Other factors may exacerbate angina either by further restricting oxygen delivery (for example severe anaemia) or by increasing oxygen demand (for example left ventricular hypertrophy). Angina symptoms are associated with other cardiac disease such as aortic stenosis but the management of angina associated with non-coronary artery disease is outside the scope of this guideline.

NICE Clinical Guidelines - National Clinical Guidelines Centre (UK).

Version: July 2011
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Diagnosis and Management of Infantile Hemangioma [Internet]

To systematically review evidence addressing the diagnosis and management of infantile hemangiomas (IH).

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: January 2016
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Beta‐1 selective blockers for treatment of high blood pressure

Beta‐1 selective blockers are a subclass of beta blockers that are commonly used to treat high blood pressure. Drugs in this class include atenolol (Tenormin), metoprolol (Lopressor), nebivolol (Bystolic) and bisoprolol (Zebeta, Monocor). We developed a comprehensive methodology to examine how different doses and drugs in this class of drugs lower blood pressure.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Treatment of high blood pressure for people with peripheral arterial disease

When blood pressure is consistently high it can lead to complications such as a heart attack (myocardial infarction) or stroke. Both peripheral arterial disease (PAD), a condition that affects the blood vessels (arteries) carrying the blood to the legs, arms, and stomach area, and high blood pressure (hypertension) are associated with atherosclerosis. This is hardening of the arteries which is caused by deposits of fat, cholesterol and other substances inside the blood vessels. PAD is diagnosed when the blood supply to the legs is restricted causing pain and cramping that limits walking (intermittent claudication). It is measured by the walking distance (on a treadmill) before onset of pain (claudication distance) or ankle brachial index (ABI), the ratio of the blood pressure in the arms to the blood pressure in the legs. If the blood pressure is lower in the legs compared to the arms (ABI of less than 1.0) this indicates blocked arteries in the legs (or PAD). PAD can progress to pain at rest and critical limb ischaemia (sudden lack of blood flow to a limb caused by a blood clot or fatty deposit blockage) that requires revascularisation (restoring the blood flow by opening up the blocked blood vessel) or amputation. Treatment of hypertension to reduce cardiovascular events (heart attack or stroke) and death needs careful consideration in people with PAD. Anti‐hypertensive medications may worsen the PAD symptoms by further reducing blood flow and supply of oxygen to the limbs, and may have long‐term effects on disease progression. The evidence from randomised controlled trials (RCTs) examining the risks and benefits of various anti‐hypertensive drugs on measures of PAD is lacking.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Management of Infantile Hemangioma

Access to early treatment may be critical for a subset of children facing significant impact from infantile hemangioma (IH). This is a summary of a systematic review evaluating the evidence regarding the efficacy, comparative effectiveness, and adverse effects of pharmacological and surgical therapies for IH. The systematic review included 148 unique studies published from 1982 to June 2015. The full report, listing all studies, is available at www.effectivehealthcare.ahrq.gov/infantile-hemangioma.

Comparative Effectiveness Review Summary Guides for Policymakers [Internet] - Agency for Healthcare Research and Quality (US).

Version: June 21, 2016

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