A critical analysis of nine randomized trials, including almost 70,000 hypertensive patients, illustrates that reduction in heart rate due to beta-blockers, increases the risks of all-cause death, cardiovascular death, MI, stroke, and heart failure (p < 0.0001 for all).

Dr. Franz H. Messerli, from Columbia University, said that “pharmacologically induced bradycardia may lead to dyssynchrony between outgoing and reflected pulse wave, thereby increasing central aortic pressure and the hemodynamic burden to the target organs.”

A total of 22 randomized controlled trials were recognized, of which 9 included heart rate data. All told, 34,096 patients received beta-blockers, 30,139 received other antihypertensive drugs, and 3987 received placebo.

Patients treated beta-blocker, attained lower heart rates than did other patients, this heart rate lowering was linked to adverse cardiovascular events. Moreover, the slower the heart rate, the greater the risk of cardiovascular diseases.

In an accompanying editorial, Dr. Norman M. Kaplan, from the University of Texas, comments that the present research “adds another post-mortem explanation for the fall of beta-blockers, showing higher mortality associated with the slower heart rate they induce.”

He adds that “with this addition to the evidence, beta-blockers will surely remain as indicated for heart failure, for after MI, and for tachyarrhythmias, but no longer for hypertension in the absence of these compelling indications.”

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