Reuters Health Medical News|July 14, 2020
Among women with no prior history of cardiovascular disease, taking beta blockers for hypertension raises the risk of heart failure, a new study suggests.
Among thousands of patients presenting to the hospital with acute coronary syndrome, more women taking beta blockers (21.3%) than men (16.7%) had heart failure, translating to 35% greater relative risk for women, researchers report in Hypertension.
“What we found presents a solid case for re-examination of the use of beta blocker therapy for women with hypertension and no prior heart disease,” said the study’s lead author Dr. Raffaele Bugiardini, a professor of cardiology in the department of experimental, diagnostic and specialty medicine at the University of Bologna, in Italy.
“In simple words, women’s hearts are more fragile and susceptible than men’s to break during a heart attack,” Dr. Bugiardini said in an email. “Beta blockers increase such fragility.”
Beta blockers are already contraindicated in patients with overt heart failure because of their negative effects on myocardial contractility, Dr. Bugiardini said. Moreover, he said, “women who have myocardial infarction are at higher risk to develop heart failure compared with men, and women with heart failure have worse survival than do their male counterparts with heart failure. The use of beta blockers enhances such female-sex specific vulnerability to heart failure in the case of incident heart attack and increases the risk of mortality.”
To take a closer look at sex-specific differences in the impact of beta blockers, Dr. Bugiardini and his colleagues analyzed data from the International Survey of Acute Coronary Syndromes (ISACS) Archives collected between October 2010 and July 2018, including information from two large clinical trials.
Data on a total of 13,764 adults in 12 European countries who had hypertension and no prior history of cardiovascular disease were analyzed. Patients were classified by gender and then separated into two groups: those taking beta blockers and those who were not.
In contrast with the 4.6% absolute difference in heart failure risk between men and women prescribed beta blockers before admission to the hospital, the rate of heart failure was similar between men (16.1%) and women (17.2%) not taking beta blockers.
Heart failure was also predictive of mortality in both genders. Compared to patients without heart failure, women (odds ratio 7.54) and men (OR 9.62) with heart failure had higher mortality at 30 days.
Dr. Bugiardini thinks the study results should give doctors pause when it comes to prescribing beta blockers to women with high blood pressure.
“The safety of a medication is as important to the clinician and the person as is the effectiveness,” he said. “For women who have no history of cardiovascular disease and only hypertension, we think it may be best for them to regulate their blood pressure in other ways such as using other medications and of course through diet and exercise.”
The new findings came as a surprise to Dr. Johanna Contreras, director of heart failure at Mount Sinai in New York City.
“It’s great that they are looking at this, but the data are skewed in that there are a very limited number of women,” Dr. Contreras said. “I’m not saying that it is wrong, but it could be by chance. We don’t know how long the patients were taking beta blockers and we don’t know if they were taking other blood pressure medications. So, I think we need to take this study with a grain of salt.”
Dr. Contreras isn’t ready to change patient prescriptions just yet.
“We don’t know how long the patients had hypertension,” she said. “We don’t know if it was controlled. We know if you don’t control hypertension heart attacks and heart failure are more likely. This is just an association. I would be very hesitant to tell women to stop taking beta blockers.”
With that said, Dr. Contreras currently does not use beta blockers as a first line treatment for hypertension and instead prefers to use a diuretic or an ACE-inhibitor to start for most patients.
“I reserve beta blockers for people with arrhythmia,” Dr. Contreras said. “Beta blockers are not my first line usually, but everyone is different. You have to find the right medication for the right patient.”
—Linda Carroll