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April 14, 1989, Vol 261, No. 14 >
ARTICLE | April 14, 1989

β-Blockers and Primary Prevention of Coronary Heart Disease in Patients With High Blood Pressure FREE

Bruce M. Psaty, MD, PhD; Thomas D. Koepsell, MD, MPH; James P. LoGerfo, MD, MPH; Edward H. Wagner, MD, MPH; Thomas S. Inui, ScM, MD
[+] Author Affiliations

The opinions, conclusions, and proposals in the text are those of the authors and do not necessarily reflect those of the agencies that provided funding for this research.

Reprint requests to Department of Medicine, ZA-60, Harborview Medical Center, 325 Ninth Ave, Seattle, WA 98104 (Dr Psaty).


JAMA. 1989;261(14):2087-2094. doi:10.1001/jama.1989.03420140089033
Text Size: A A A
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Article
References

We conducted a population-based, case-control study to determine whether β-blockers, used for the treatment of hypertension, prevent first events of coronary heart disease. Cases were patients who had high blood pressure treated with medicines and who presented in 1982 to 1984 with angina or fatal or nonfatal myocardial infarction. Controls were a probability sample of health maintenance organization patients with pharmacologically treated hypertension and free of coronary heart disease. Blinded to case-control status, we reviewed the medical records of the 248 cases and 737 controls. The health maintenance organization's computerized pharmacy database was used to ascertain the use of β-blockers. Fewer cases than controls were taking β-blockers. This difference was confined to those with nonfatal infarctions. After adjustment for confounding, the estimated relative risk was 0.62 (95% confidence interval, 0.39 to 0.99). Higher doses of β-blockers conferred greater protection. We conclude that β-blockers may prevent first events of nonfatal myocardial infarction in patients with high blood pressure.

(JAMA. 1989;261:2087-2094)

REFERENCES

1 +
Veterans Administration Cooperative Study Group on Antihypertensive Agents.  Effects of treatment on morbidity in hypertension: results in patients with diastolic blood pressures averaging 115 through 129 mm Hg . JAMA . 1967;;202:116-122.
2 +
Veterans Administration Cooperative Study Group on Antihypertensive Agents.  II. Effects of treatment: results in patients with diastolic blood pressure averaging 90 through 114 mm Hg . JAMA . 1970;;213:1143-1152.
3 +
The Management Committee of the Australian National Blood Pressure Study.  The Australian therapeutic trial in mild hypertension . Lancet . 1980;;1:1262-1267.
4 +
The Management Committee of the Australian Therapeutic Trial in Mild Hypertension.  Untreated mild hypertension . Lancet. 1982;;1:185-191.
5 +
Smith WM, for the US Public Health Service Hospitals Cooperative Study Group.  Treatment of mild hypertension: results of a ten-year intervention trial . Hypertension . 1977;;25( (suppl 1) ):I98-I105.
6 +
Hegeland A.  Treatment of mild hypertension: a five year controlled drug trial: the Oslo study . Am J Med. 1980;;69:725-732.
7 +
Hypertension Detection and Follow-up Program Cooperative Group.  Five-year findings of the hypertension detection and follow-up program, I: reduction in mortality of persons with high blood pressure, including mild hypertension . JAMA . 1979;;242:2562-2571.
8 +
Hypertension Detection and Follow-up Program Cooperative Group. Five-year findings of the hypertension detection and follow-up program, II: mortality by race, sex, and age. JAMA . 1979;;242: 2572-2577.
9 +
Amery A, Birkenhager W, Brixko P, et al.  Mortality and morbidity from the European Working Party on High Blood Pressure in the Elderly trial . Lancet . 1985;;1:1350-1354.
10 +
Amery A, Brixko R, Clement D, et al.  Efficacy of anti-hypertensive drug treatment according to age, sex, blood pressure, and previous cardiovascular disease in patients over the age of 60 . Lancet . 1986;;2:589-595.
11 +
Multiple Risk Factor Intervention Trial Research Group.  Multiple risk factor intervention trial: risk factor changes and mortality results . JAMA . 1982;;248:1465-1477.
12 +
MacMahon SW, Cutler JA, Furberg CD, et al.  The effects of drug treatment for hypertension on morbidity and mortality from cardiovascular disease: a review of randomized controlled trials . Prog Cardiovasc Dis. 1986;;29( (suppl 1) ):99-118.
13 +
Grimm RH, Leon AS, Hunninghake DB, et al.  Effects of thiazide diuretics on plasma lipids and lipoproteins in mildly hypertensive patients . Ann Intern Med. 1981;;94:7-11.
14 +
Shand DG.  Drug therapy: propranolol . N Engl J Med. 1975;;293:280-285.
15 +
β-Blocker Heart Attack Trial Research Group.  A randomized trial of propranolol in patients with acute myocardial infarction, I: mortality results . JAMA. 1982;;247:1707-1714.
16 +
β-Blocker Heart Attack Trial Research Group.  A randomized trial of propranolol in patients with acute myocardial infarction, II: morbidity results . JAMA 1983;;250:2814-2818.
17 +
The Norwegian Multicenter Study Group.  Timolol-induced reduction in mortality and reinfarction in patients surviving acute myocardial infarction . N Engl J Med. 1981;;304:801-807.
18 +
Hjalmarson A, Elmfeldt D, Herlitz J, et al.  Effect on mortality of metoprolol in acute myocardial infarction: a double-blind randomized trial . Lancet . 1981;;2:823-827.
19 +
Yusuf S, Peto R, Lewis J, et al.  Beta blockade during and after myocardial infarction: an overview of the randomized trials . Prog Cardiovasc Dis. 1985;;27:335-371.
20 +
Medical Research Council Working Party.  MRC trial of treatment of mild hypertension: principal results . Br Med J. 1985;;291:97-104.
21 +
The IPPPSH Collaborative Group.  Cardiovascular risk and risk factors in a randomized trial of treatment based on the betablocker oxprenolol: the International Prospective Primary Prevention Study in Hypertension (IPPPSH) . J Hypertens. 1985;;3:379-392.
22 +
Wilhelmsen L, Berglund G, Elmfeldt D, et al.  Beta-blockers versus diuretics in hypertensive men: main results from the HAPPHY trial . J Hypertens . 1987;;5:561-572.
23 +
Wikstrand J, Warnold I, Olsson G, Tuomilehto J, Elmfedt D, Berglund G.  Primary prevention with metoprolol in patients with hypertension: mortality results from the MAPHY Study . JAMA . 1988;;259:1976-1982.
24 +
Wikstrand J.  Beta-blockers and cardioprotection—is there any good news from the recent trials? J Clin Pharm Ther. 1987;;12:347-350.
25 +
Jick H, Watkins RN, Hunter JR, et al.  Replacement estrogens and endometrial cancer . N Engl J Med. 1979;;300:218-222.
26 +
 Myocardial infarction community registers: results of a WHO international collaborative study coordinated by the regional office for Europe . Public Health in Europe . Copenhagen, Denmark: World Health Organization; 1977;:5.
27 +
Folsom AR, Gomez-Marin O, Gillum RF, Kottke TE, Lohman W, Jacobs JR.  Out-of-hospital coronary death in an urban population-validation of death certificate diagnosis: the Minnesota Heart Survey . Am J Epidemiol. 1987;;125:1012-1015.
28 +
Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure.  The 1980 report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure . Arch Intern Med. 1980;;140:1280-1285.
29 +
Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure.  The 1984 report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure . Arch Intern Med. 1984;;144:1045-1057.
30 +
Weiner N.  Drugs that inhibit adrenergic nerves and block adrenergic receptors . In: Gilman AG, Goodman LS, Rail TW, Murad F, eds. The Pharmacological Basis of Therapeutics . 7th ed. New York, NY: Macmillan Publishers Co Inc; 1985;:181-210.
31 +
Heel RC, Brogden RN, Pakes GE, Speight TM, Avery GS.  Nadolol: a review of its pharmacological properties and therapeutic efficacy in hypertension and angina pectoris . Drugs . 1980;;20:1-23.
32 +
Nilsson OR, Atterhog J, Castenfors J, et al.  A comparison of 100 mg atenolol and 100 mg metoprolol once a day at rest and during exercise in hypertensives . Acta Med Scand . 1984;;216:301-307.
33 +
Ravid M, Lang R, Jutrin I.  The relative antihypertensive potency of propranolol, oxprenolol, atenolol, and metoprolol given once daily . Arch Intern Med. 1985;;145:1321-1323.
34 +
Shepard DS, Neutra ME.  A pitfall in sampling medical visits . Am J Public Health. 1977;;67:743-750.
35 +
Schlesselman JJ. Case-Control Studies: Design, Conduct, Analysis . New York, NY: Oxford University Press; 1982;.
36 +
Breslow NE, Day NE. The Analysis of Case-Control Studies. Volume 1. In: Statistical Methods in Cancer Research . Lyon, France: International Agency for Research on Cancer; 1980;.IARC Scientific Publication 32.
37 +
McCullagh P, Nelder JA. Generalized Linear Models . London, England: Chapman & Hall; 1983;.
38 +
Psaty BM, Koepsell TD, LoGerfo JP, Wagner EH, Inui TS.  The relative risk of myocardial infarction in patients who have high blood pressure and non-cardiac chest pain . J Gen Intern Med. 1987;;2:381-387.
39 +
Martin CA, Chung KC, Lim W, Wong KK.  The problem of home management in the estimation of the incidence of acute myocardial infarction from hospital records . J Chronic Dis. 1986;;39:683-686.
40 +
Veterans Administration Cooperative Study Group on Antihypertensive Agents.  Comparison of propranolol and hydrochlorothiazide for the initial treatment of hypertension, II: results of long-term therapy . JAMA . 1982;;248:2004-2010.
41 +
The Pooling Project Research Group.  Relationship of blood pressure, serum cholesterol, smoking habit, relative weight and ECG abnormalities to the incidence of major coronary events: final results of the pooling project . J Chronic Dis. 1978;;31:201-306.
42 +
Kjekshus J.  Comments—beta-blockers: heart rate reduction a mechanism of benefit . Eur Heart J. 1985;;6( (suppl A) ):29-30.
43 +
Beere PA, Glagov S, Zarins CK.  Retarding effect of lowered heart rate on coronary atherosclerosis . Science . 1984;;226:180-182.
44 +
Spence JD.  Hemodynamic effects of antihypertensive drugs: possible implications for the prevention of atherosclerosis . Hypertension . 1984;;6( (suppl 3) ):163-168.
45 +
Morganroth MD, Lichstein E, Byington R.  Beta-blocker heart attack trial: impact of propranolol therapy on ventricular arrhythmias . Prev Med. 1985;;14:346-357.
46 +
Laustiola K, Kaukinen S, Seppala E, Jokela T, Vapaatalo H.  Adrenaline infusion evokes increased thromboxane B2 production by platelets in healthy men: the effect of beta-adrenoceptor blockage . Eur J Clin Invest. 1986;;16:473-479.
47 +
Kerry R, Scrutton MC, Wallis RB.  Beta-adrenoceptor antagonists and human platelets: relationship of effects to lipid solubility . Biochem Pharmacol. 1984;;33:2615-2622.
48 +
Srivastava KD.  Influence of some beta blockers (pindolol, atenolol, timolol and metoprolol) on aggregation and arachidonic acid metabolism in human platelets . Prostaglandins Leukotrienes Med. 1987;:29:79-84.
49 +
Mikhailidis MD, Barradas MA, Mier A, et al.  Platelet function in patients admitted with a diagnosis of myocardial infarction . Angiology . 1987;;36-45.
50 +
Nosal R, Jancinova V, Ondrias K, et al.  The interaction of beta-adrenoceptor blocking drugs with platelet aggregation, calcium displacement and fluidization of the membrane . Biochim Biophys Acta . 1985;;821:217-228.
51 +
Tofler GH, Brezinski D, Schafer AI, et al.  Concurrent morning increase in platelet aggregability and the risk of myocardial infarction and sudden cardiac death . N Engl J Med. 1987;;316:1514-1518.
52 +
Muller JE, Stone PH, Zoltan GT, et al.  Circadian variation in the frequency of onset of acute myocardial infarction . N Engl J Med. 1985;;313:1315-1322.
53 +
Canner PL, Forman SA, Prudhomme GJ, Berge KG, Stamler J, for the Coronary Drug Project Research Group.  Influence of adherence to treatment and response of cholesterol on mortality in the coronary drug project . N Engl J Med. 1980;;303:1038-1041.
54 +
1988 Joint National Committee.  The 1988 report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure . Arch Intern Med. 1988;;148:1023-1038.
55 +
Stamler J, Prineas RJ, Neaton JD, et al.  Background and design of the new US trial on diet and drug treatment of 'mild' hypertension (TOMHS) . Am J Cardiol. 1987;;59:51G-60G.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Veterans Administration Cooperative Study Group on Antihypertensive Agents.  Effects of treatment on morbidity in hypertension: results in patients with diastolic blood pressures averaging 115 through 129 mm Hg . JAMA . 1967;;202:116-122.
2 +
Veterans Administration Cooperative Study Group on Antihypertensive Agents.  II. Effects of treatment: results in patients with diastolic blood pressure averaging 90 through 114 mm Hg . JAMA . 1970;;213:1143-1152.
3 +
The Management Committee of the Australian National Blood Pressure Study.  The Australian therapeutic trial in mild hypertension . Lancet . 1980;;1:1262-1267.
4 +
The Management Committee of the Australian Therapeutic Trial in Mild Hypertension.  Untreated mild hypertension . Lancet. 1982;;1:185-191.
5 +
Smith WM, for the US Public Health Service Hospitals Cooperative Study Group.  Treatment of mild hypertension: results of a ten-year intervention trial . Hypertension . 1977;;25( (suppl 1) ):I98-I105.
6 +
Hegeland A.  Treatment of mild hypertension: a five year controlled drug trial: the Oslo study . Am J Med. 1980;;69:725-732.
7 +
Hypertension Detection and Follow-up Program Cooperative Group.  Five-year findings of the hypertension detection and follow-up program, I: reduction in mortality of persons with high blood pressure, including mild hypertension . JAMA . 1979;;242:2562-2571.
8 +
Hypertension Detection and Follow-up Program Cooperative Group. Five-year findings of the hypertension detection and follow-up program, II: mortality by race, sex, and age. JAMA . 1979;;242: 2572-2577.
9 +
Amery A, Birkenhager W, Brixko P, et al.  Mortality and morbidity from the European Working Party on High Blood Pressure in the Elderly trial . Lancet . 1985;;1:1350-1354.
10 +
Amery A, Brixko R, Clement D, et al.  Efficacy of anti-hypertensive drug treatment according to age, sex, blood pressure, and previous cardiovascular disease in patients over the age of 60 . Lancet . 1986;;2:589-595.
11 +
Multiple Risk Factor Intervention Trial Research Group.  Multiple risk factor intervention trial: risk factor changes and mortality results . JAMA . 1982;;248:1465-1477.
12 +
MacMahon SW, Cutler JA, Furberg CD, et al.  The effects of drug treatment for hypertension on morbidity and mortality from cardiovascular disease: a review of randomized controlled trials . Prog Cardiovasc Dis. 1986;;29( (suppl 1) ):99-118.
13 +
Grimm RH, Leon AS, Hunninghake DB, et al.  Effects of thiazide diuretics on plasma lipids and lipoproteins in mildly hypertensive patients . Ann Intern Med. 1981;;94:7-11.
14 +
Shand DG.  Drug therapy: propranolol . N Engl J Med. 1975;;293:280-285.
15 +
β-Blocker Heart Attack Trial Research Group.  A randomized trial of propranolol in patients with acute myocardial infarction, I: mortality results . JAMA. 1982;;247:1707-1714.
16 +
β-Blocker Heart Attack Trial Research Group.  A randomized trial of propranolol in patients with acute myocardial infarction, II: morbidity results . JAMA 1983;;250:2814-2818.
17 +
The Norwegian Multicenter Study Group.  Timolol-induced reduction in mortality and reinfarction in patients surviving acute myocardial infarction . N Engl J Med. 1981;;304:801-807.
18 +
Hjalmarson A, Elmfeldt D, Herlitz J, et al.  Effect on mortality of metoprolol in acute myocardial infarction: a double-blind randomized trial . Lancet . 1981;;2:823-827.
19 +
Yusuf S, Peto R, Lewis J, et al.  Beta blockade during and after myocardial infarction: an overview of the randomized trials . Prog Cardiovasc Dis. 1985;;27:335-371.
20 +
Medical Research Council Working Party.  MRC trial of treatment of mild hypertension: principal results . Br Med J. 1985;;291:97-104.
21 +
The IPPPSH Collaborative Group.  Cardiovascular risk and risk factors in a randomized trial of treatment based on the betablocker oxprenolol: the International Prospective Primary Prevention Study in Hypertension (IPPPSH) . J Hypertens. 1985;;3:379-392.
22 +
Wilhelmsen L, Berglund G, Elmfeldt D, et al.  Beta-blockers versus diuretics in hypertensive men: main results from the HAPPHY trial . J Hypertens . 1987;;5:561-572.
23 +
Wikstrand J, Warnold I, Olsson G, Tuomilehto J, Elmfedt D, Berglund G.  Primary prevention with metoprolol in patients with hypertension: mortality results from the MAPHY Study . JAMA . 1988;;259:1976-1982.
24 +
Wikstrand J.  Beta-blockers and cardioprotection—is there any good news from the recent trials? J Clin Pharm Ther. 1987;;12:347-350.
25 +
Jick H, Watkins RN, Hunter JR, et al.  Replacement estrogens and endometrial cancer . N Engl J Med. 1979;;300:218-222.
26 +
 Myocardial infarction community registers: results of a WHO international collaborative study coordinated by the regional office for Europe . Public Health in Europe . Copenhagen, Denmark: World Health Organization; 1977;:5.
27 +
Folsom AR, Gomez-Marin O, Gillum RF, Kottke TE, Lohman W, Jacobs JR.  Out-of-hospital coronary death in an urban population-validation of death certificate diagnosis: the Minnesota Heart Survey . Am J Epidemiol. 1987;;125:1012-1015.
28 +
Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure.  The 1980 report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure . Arch Intern Med. 1980;;140:1280-1285.
29 +
Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure.  The 1984 report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure . Arch Intern Med. 1984;;144:1045-1057.
30 +
Weiner N.  Drugs that inhibit adrenergic nerves and block adrenergic receptors . In: Gilman AG, Goodman LS, Rail TW, Murad F, eds. The Pharmacological Basis of Therapeutics . 7th ed. New York, NY: Macmillan Publishers Co Inc; 1985;:181-210.
31 +
Heel RC, Brogden RN, Pakes GE, Speight TM, Avery GS.  Nadolol: a review of its pharmacological properties and therapeutic efficacy in hypertension and angina pectoris . Drugs . 1980;;20:1-23.
32 +
Nilsson OR, Atterhog J, Castenfors J, et al.  A comparison of 100 mg atenolol and 100 mg metoprolol once a day at rest and during exercise in hypertensives . Acta Med Scand . 1984;;216:301-307.
33 +
Ravid M, Lang R, Jutrin I.  The relative antihypertensive potency of propranolol, oxprenolol, atenolol, and metoprolol given once daily . Arch Intern Med. 1985;;145:1321-1323.
34 +
Shepard DS, Neutra ME.  A pitfall in sampling medical visits . Am J Public Health. 1977;;67:743-750.
35 +
Schlesselman JJ. Case-Control Studies: Design, Conduct, Analysis . New York, NY: Oxford University Press; 1982;.
36 +
Breslow NE, Day NE. The Analysis of Case-Control Studies. Volume 1. In: Statistical Methods in Cancer Research . Lyon, France: International Agency for Research on Cancer; 1980;.IARC Scientific Publication 32.
37 +
McCullagh P, Nelder JA. Generalized Linear Models . London, England: Chapman & Hall; 1983;.
38 +
Psaty BM, Koepsell TD, LoGerfo JP, Wagner EH, Inui TS.  The relative risk of myocardial infarction in patients who have high blood pressure and non-cardiac chest pain . J Gen Intern Med. 1987;;2:381-387.
39 +
Martin CA, Chung KC, Lim W, Wong KK.  The problem of home management in the estimation of the incidence of acute myocardial infarction from hospital records . J Chronic Dis. 1986;;39:683-686.
40 +
Veterans Administration Cooperative Study Group on Antihypertensive Agents.  Comparison of propranolol and hydrochlorothiazide for the initial treatment of hypertension, II: results of long-term therapy . JAMA . 1982;;248:2004-2010.
41 +
The Pooling Project Research Group.  Relationship of blood pressure, serum cholesterol, smoking habit, relative weight and ECG abnormalities to the incidence of major coronary events: final results of the pooling project . J Chronic Dis. 1978;;31:201-306.
42 +
Kjekshus J.  Comments—beta-blockers: heart rate reduction a mechanism of benefit . Eur Heart J. 1985;;6( (suppl A) ):29-30.
43 +
Beere PA, Glagov S, Zarins CK.  Retarding effect of lowered heart rate on coronary atherosclerosis . Science . 1984;;226:180-182.
44 +
Spence JD.  Hemodynamic effects of antihypertensive drugs: possible implications for the prevention of atherosclerosis . Hypertension . 1984;;6( (suppl 3) ):163-168.
45 +
Morganroth MD, Lichstein E, Byington R.  Beta-blocker heart attack trial: impact of propranolol therapy on ventricular arrhythmias . Prev Med. 1985;;14:346-357.
46 +
Laustiola K, Kaukinen S, Seppala E, Jokela T, Vapaatalo H.  Adrenaline infusion evokes increased thromboxane B2 production by platelets in healthy men: the effect of beta-adrenoceptor blockage . Eur J Clin Invest. 1986;;16:473-479.
47 +
Kerry R, Scrutton MC, Wallis RB.  Beta-adrenoceptor antagonists and human platelets: relationship of effects to lipid solubility . Biochem Pharmacol. 1984;;33:2615-2622.
48 +
Srivastava KD.  Influence of some beta blockers (pindolol, atenolol, timolol and metoprolol) on aggregation and arachidonic acid metabolism in human platelets . Prostaglandins Leukotrienes Med. 1987;:29:79-84.
49 +
Mikhailidis MD, Barradas MA, Mier A, et al.  Platelet function in patients admitted with a diagnosis of myocardial infarction . Angiology . 1987;;36-45.
50 +
Nosal R, Jancinova V, Ondrias K, et al.  The interaction of beta-adrenoceptor blocking drugs with platelet aggregation, calcium displacement and fluidization of the membrane . Biochim Biophys Acta . 1985;;821:217-228.
51 +
Tofler GH, Brezinski D, Schafer AI, et al.  Concurrent morning increase in platelet aggregability and the risk of myocardial infarction and sudden cardiac death . N Engl J Med. 1987;;316:1514-1518.
52 +
Muller JE, Stone PH, Zoltan GT, et al.  Circadian variation in the frequency of onset of acute myocardial infarction . N Engl J Med. 1985;;313:1315-1322.
53 +
Canner PL, Forman SA, Prudhomme GJ, Berge KG, Stamler J, for the Coronary Drug Project Research Group.  Influence of adherence to treatment and response of cholesterol on mortality in the coronary drug project . N Engl J Med. 1980;;303:1038-1041.
54 +
1988 Joint National Committee.  The 1988 report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure . Arch Intern Med. 1988;;148:1023-1038.
55 +
Stamler J, Prineas RJ, Neaton JD, et al.  Background and design of the new US trial on diet and drug treatment of 'mild' hypertension (TOMHS) . Am J Cardiol. 1987;;59:51G-60G.

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