بررسی اثربخشی بتابلاکرهای غیرانتخابی در کاهش فشار خون در هیپرتانسیون اولیه
Information
- DOI:
- https://doi.org/10.1002/14651858.CD007452.pub2Copy DOI
- Database:
-
- Cochrane Database of Systematic Reviews
- Version published:
-
- 28 February 2014see what's new
- Type:
-
- Intervention
- Stage:
-
- Review
- Cochrane Editorial Group:
-
Cochrane Hypertension Group
- Copyright:
-
- Copyright © 2014 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Article metrics
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Cited by:
Authors
Contributions of authors
James Wright formulated the idea for the review, developed the basis for the protocol, supervised the data analysis and interpretation, and contributed to the final draft of the review.
Gavin Wong took the lead role in searching, identifying and assessing studies; in data extraction and analyses; and in writing the first draft of the review.
Sources of support
Internal sources
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University of British Columbia, Department of Anesthesiology, Pharmacology & Therapeutics, Canada.
External sources
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Canadian Institutes of Health Research, Canada.
Declarations of interest
None known.
Acknowledgements
The review authors would like to acknowledge the help provided by the Cochrane Hypertension Group and thank Stephen Adams for retrieving the full text of the studies. Alexandra Laugerotte confirmed the eligibility of included studies and independently extracted the data.
Version history
| Published | Title | Stage | Authors | Version |
| 2014 Feb 28 | Blood pressure lowering efficacy of nonselective beta‐blockers for primary hypertension | Review | Gavin WK Wong, James M Wright | |
| 2008 Oct 08 | Blood pressure lowering efficacy of non‐selective beta blockers for primary hypertension | Protocol | Gavin WK Wong, Alexandra Laugerotte, James M Wright | |
Keywords
MeSH
Medical Subject Headings (MeSH) Keywords
Medical Subject Headings Check Words
Humans;
PICOs
Funnel plot of systolic blood pressure of 2x starting dose propranolol.
Funnel plot of diastolic blood pressure of 2x starting dose propranolol.
Comparison 1 Propranolol versus placebo, Outcome 1 Systolic blood pressure.
Comparison 1 Propranolol versus placebo, Outcome 2 Diastolic blood pressure.
Comparison 1 Propranolol versus placebo, Outcome 3 Heart rate.
Comparison 1 Propranolol versus placebo, Outcome 4 Pulse pressure.
Comparison 1 Propranolol versus placebo, Outcome 5 Direct comparison 2x doses.
Comparison 2 Timolol versus placebo, Outcome 1 Systolic blood pressure.
Comparison 2 Timolol versus placebo, Outcome 2 Diastolic blood pressure.
Comparison 2 Timolol versus placebo, Outcome 3 Heart rate.
Comparison 2 Timolol versus placebo, Outcome 4 Pulse pressure.
Comparison 3 Penbutolol versus placebo, Outcome 1 Systolic blood pressure.
Comparison 3 Penbutolol versus placebo, Outcome 2 Diastolic blood pressure.
Comparison 3 Penbutolol versus placebo, Outcome 3 Heart rate.
Comparison 3 Penbutolol versus placebo, Outcome 4 Pulse pressure.
Comparison 4 Tertatolol versus placebo, Outcome 1 Systolic blood pressure.
Comparison 4 Tertatolol versus placebo, Outcome 2 Diastolic blood pressure.
Comparison 4 Tertatolol versus placebo, Outcome 3 Heart rate.
Comparison 4 Tertatolol versus placebo, Outcome 4 Pulse pressure.
Comparison 5 Indenolol versus placebo, Outcome 1 Heart rate.
Comparison 6 Nadolol versus placebo, Outcome 1 Heart rate.
Comparison 7 Moprolol versus placebo, Outcome 1 Heart rate.
Comparison 8 Pooled subclass effects (NSBB: nonselective beta‐blocker), Outcome 1 Systolic blood pressure.
Comparison 8 Pooled subclass effects (NSBB: nonselective beta‐blocker), Outcome 2 Diastolic blood pressure.
Comparison 8 Pooled subclass effects (NSBB: nonselective beta‐blocker), Outcome 3 Heart rate.
Comparison 8 Pooled subclass effects (NSBB: nonselective beta‐blocker), Outcome 4 Pulse pressure.
Comparison 8 Pooled subclass effects (NSBB: nonselective beta‐blocker), Outcome 5 Withdrawal due to adverse effects.
Comparison 8 Pooled subclass effects (NSBB: nonselective beta‐blocker), Outcome 6 Combined 1x and 2x starting dose estimates.
| Nonselective beta‐blockers compared with placebo for primary hypertension | |||
| Patient or population: adults with primary hypertension Intervention: nonselective beta‐blockers Comparison: placebo | |||
| Outcomes | Mean estimates of combining 1x and 2x starting dose (95% CI) | Number of participants in the subgroups (# of studies) | Quality of the evidence |
| SBP (mmHg) | ‐9.5 (‐10.9 to ‐8.1)1,2,3,7 | 948 (16) | Low4,5 |
| DBP (mmHg) | ‐6.6 (‐7.4 to ‐5.8)1,2,3,7 | 948 (16) | Low4,5 |
| Heart rate (beats per minute) | ‐11.8 (‐12.9 to ‐10.7)1,2 | 864 (13) | Low4,5 |
| Pulse pressure (mmHg) | ‐2.0 (‐3.2 to ‐0.9)1,2,3 | 948 (16) | Very low4,5,6 |
| Withdrawal due to adverse effect | 0.84 (0.38 to 1.82) | 729 (2) | Low8,9 |
| CI: confident interval; DBP: diastolic blood pressure; HR: heart rate; SBP: systolic blood pressure. | |||
| GRADE Working Group grades of evidence | |||
| Footnotes | |||
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| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Systolic blood pressure Show forest plot | 18 | Mean Difference (Fixed, 95% CI) | Subtotals only | |
| 1.1 (1x starting dose) 60, 80 mg/day | 3 | 222 | Mean Difference (Fixed, 95% CI) | ‐4.67 [‐8.13, ‐1.21] |
| 1.2 (2x starting dose) 120, 160 and 180 mg/day | 13 | 592 | Mean Difference (Fixed, 95% CI) | ‐12.15 [‐14.61, ‐9.69] |
| 1.3 (4x starting dose) 240 and 320 mg/day | 6 | 99 | Mean Difference (Fixed, 95% CI) | ‐21.01 [‐25.43, ‐16.58] |
| 1.4 (8x starting dose) 480 and 640 mg/day | 2 | 205 | Mean Difference (Fixed, 95% CI) | ‐4.31 [‐9.60, 0.97] |
| 2 Diastolic blood pressure Show forest plot | 18 | Mean Difference (Fixed, 95% CI) | Subtotals only | |
| 2.1 (1x starting dose) 60 and 80 mg/day | 3 | 222 | Mean Difference (Fixed, 95% CI) | ‐3.28 [‐5.60, ‐0.95] |
| 2.2 (2x starting dose) 120, 160 and 180 mg/day | 13 | 592 | Mean Difference (Fixed, 95% CI) | ‐8.51 [‐8.00, ‐7.03] |
| 2.3 (4x starting dose) 240 and 320 mg/day | 6 | 99 | Mean Difference (Fixed, 95% CI) | ‐13.91 [‐16.74, ‐11.09] |
| 2.4 (8x starting dose) 480 and 640 mg/day | 2 | 205 | Mean Difference (Fixed, 95% CI) | ‐3.03 [‐6.06, 0.00] |
| 3 Heart rate Show forest plot | 12 | Mean Difference (Fixed, 95% CI) | Subtotals only | |
| 3.1 (1x starting dose) 60 and 80 mg/day | 2 | 196 | Mean Difference (Fixed, 95% CI) | ‐7.30 [‐9.49, ‐5.12] |
| 3.2 (2x starting dose) 120 and 160 mg/day | 9 | 497 | Mean Difference (Fixed, 95% CI) | ‐11.54 [‐12.95, ‐10.13] |
| 3.3 (4x starting dose) 240 and 320 mg/day | 5 | 85 | Mean Difference (Fixed, 95% CI) | ‐18.38 [‐20.93, ‐15.84] |
| 3.4 (8x starting dose) 640 mg/day | 1 | 108 | Mean Difference (Fixed, 95% CI) | ‐10.0 [‐12.76, ‐7.24] |
| 4 Pulse pressure Show forest plot | 18 | Mean Difference (Fixed, 95% CI) | Subtotals only | |
| 4.1 (1x starting dose) 60 and 80 mg/day | 3 | 222 | Mean Difference (Fixed, 95% CI) | ‐1.45 [‐4.79, 1.88] |
| 4.2 (2x starting dose) 120, 160 and 180 mg/day | 13 | 618 | Mean Difference (Fixed, 95% CI) | ‐2.52 [‐4.25, ‐0.79] |
| 4.3 (4x starting dose) 240 and 320 mg/day | 6 | 99 | Mean Difference (Fixed, 95% CI) | ‐2.96 [‐6.50, 0.58] |
| 4.4 (8x starting dose) 480 and 640 mg/day | 2 | 205 | Mean Difference (Fixed, 95% CI) | ‐2.29 [‐8.42, 3.83] |
| 5 Direct comparison 2x doses Show forest plot | 3 | Mean Difference (Fixed, 95% CI) | Subtotals only | |
| 5.1 Systolic blood pressure | 3 | 222 | Mean Difference (Fixed, 95% CI) | ‐3.01 [‐5.91, ‐0.11] |
| 5.2 Diastolic blood pressure | 3 | 222 | Mean Difference (Fixed, 95% CI) | ‐1.53 [‐3.38, 0.32] |
| 5.3 Heart rate | 2 | 196 | Mean Difference (Fixed, 95% CI) | ‐3.37 [‐5.55, ‐1.20] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Systolic blood pressure Show forest plot | 1 | Mean Difference (Fixed, 95% CI) | Subtotals only | |
| 1.1 30 mg/day | 1 | 20 | Mean Difference (Fixed, 95% CI) | ‐14.4 [‐21.53, ‐7.27] |
| 2 Diastolic blood pressure Show forest plot | 1 | Mean Difference (Fixed, 95% CI) | Subtotals only | |
| 2.1 30 mg/day | 1 | 20 | Mean Difference (Fixed, 95% CI) | ‐13.50 [‐18.05, ‐8.95] |
| 3 Heart rate Show forest plot | 1 | Mean Difference (Fixed, 95% CI) | Subtotals only | |
| 3.1 30 mg/day | 1 | 20 | Mean Difference (Fixed, 95% CI) | ‐16.0 [‐18.88, ‐13.12] |
| 4 Pulse pressure Show forest plot | 1 | Mean Difference (Fixed, 95% CI) | Subtotals only | |
| 4.1 30 mg/day | 1 | 20 | Mean Difference (Fixed, 95% CI) | ‐0.9 [‐8.70, 6.90] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Systolic blood pressure Show forest plot | 2 | Mean Difference (Fixed, 95% CI) | Subtotals only | |
| 1.1 (0.5x starting dose) 10 mg/day | 1 | 155 | Mean Difference (Fixed, 95% CI) | ‐2.4 [‐8.79, 3.99] |
| 1.2 (1x starting dose) 20 mg/day | 1 | 151 | Mean Difference (Fixed, 95% CI) | ‐6.5 [‐12.99, ‐0.01] |
| 1.3 (2x starting dose) 40 mg/day | 1 | 156 | Mean Difference (Fixed, 95% CI) | ‐4.5 [‐10.87, 1.87] |
| 1.4 (4x starting dose) 80 mg/day | 1 | 10 | Mean Difference (Fixed, 95% CI) | ‐18.0 [‐31.33, ‐4.67] |
| 2 Diastolic blood pressure Show forest plot | 2 | Mean Difference (Fixed, 95% CI) | Subtotals only | |
| 2.1 (0.5x starting dose) 10 mg/day | 1 | 155 | Mean Difference (Fixed, 95% CI) | ‐2.9 [‐6.96, 1.16] |
| 2.2 (1x starting dose) 20 mg/day | 1 | 151 | Mean Difference (Fixed, 95% CI) | ‐3.7 [‐7.76, 0.36] |
| 2.3 (2x starting dose) 40 mg/day | 1 | 156 | Mean Difference (Fixed, 95% CI) | ‐3.50 [‐7.54, 0.54] |
| 2.4 (4x starting dose) 80 mg/day | 1 | 10 | Mean Difference (Fixed, 95% CI) | ‐11.1 [‐17.90, ‐4.30] |
| 3 Heart rate Show forest plot | 2 | Mean Difference (Fixed, 95% CI) | Subtotals only | |
| 3.1 (0.5x starting dose) 10 mg/day | 1 | 103 | Mean Difference (Fixed, 95% CI) | ‐1.2 [‐9.82, 7.42] |
| 3.2 (1x starting dose) 20 mg/day | 1 | 99 | Mean Difference (Fixed, 95% CI) | ‐0.40 [‐9.02, 8.22] |
| 3.3 (2x starting dose) 40 mg/day | 1 | 104 | Mean Difference (Fixed, 95% CI) | ‐2.80 [‐11.42, 5.82] |
| 3.4 (4x starting dose) 80 mg/day | 1 | 10 | Mean Difference (Fixed, 95% CI) | ‐19.7 [‐27.15, ‐12.25] |
| 4 Pulse pressure Show forest plot | 2 | Mean Difference (Fixed, 95% CI) | Subtotals only | |
| 4.1 (0.5x starting dose) 10 mg/day | 1 | 103 | Mean Difference (Fixed, 95% CI) | 0.5 [‐7.32, 8.32] |
| 4.2 (1x starting dose) 20 mg/day | 1 | 99 | Mean Difference (Fixed, 95% CI) | ‐2.8 [‐10.68, 5.08] |
| 4.3 (2x starting dose) 40 mg/day | 1 | 104 | Mean Difference (Fixed, 95% CI) | ‐1.1 [‐8.90, 6.70] |
| 4.4 (4x starting dose) 80 mg/day | 1 | 10 | Mean Difference (Fixed, 95% CI) | ‐6.9 [‐18.37, 4.57] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Systolic blood pressure Show forest plot | 1 | 20 | Mean Difference (Fixed, 95% CI) | ‐14.0 [‐26.54, ‐1.46] |
| 1.1 5 mg/day | 1 | 20 | Mean Difference (Fixed, 95% CI) | ‐14.0 [‐26.54, ‐1.46] |
| 2 Diastolic blood pressure Show forest plot | 1 | 20 | Mean Difference (Fixed, 95% CI) | ‐15.0 [‐23.33, ‐6.67] |
| 2.1 5 mg/day | 1 | 20 | Mean Difference (Fixed, 95% CI) | ‐15.0 [‐23.33, ‐6.67] |
| 3 Heart rate Show forest plot | 1 | 20 | Mean Difference (Fixed, 95% CI) | ‐17.0 [‐24.06, ‐9.94] |
| 3.1 5 mg/day | 1 | 20 | Mean Difference (Fixed, 95% CI) | ‐17.0 [‐24.06, ‐9.94] |
| 4 Pulse pressure Show forest plot | 1 | 20 | Mean Difference (Fixed, 95% CI) | 1.0 [‐10.07, 12.07] |
| 4.1 5 mg/day | 1 | 20 | Mean Difference (Fixed, 95% CI) | 1.0 [‐10.07, 12.07] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Heart rate Show forest plot | 1 | 12 | Mean Difference (Fixed, 95% CI) | ‐12.0 [‐15.37, ‐8.63] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Heart rate Show forest plot | 1 | 10 | Mean Difference (Fixed, 95% CI) | ‐20.6 [‐26.48, ‐14.72] |
| 1.1 80 mg/day | 1 | 10 | Mean Difference (Fixed, 95% CI) | ‐20.6 [‐26.48, ‐14.72] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Heart rate Show forest plot | 1 | 23 | Mean Difference (Fixed, 95% CI) | ‐6.0 [‐13.51, 1.51] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Systolic blood pressure Show forest plot | 22 | Mean Difference (Fixed, 95% CI) | Subtotals only | |
| 1.1 NSBB 0.5x starting dose | 1 | 155 | Mean Difference (Fixed, 95% CI) | ‐2.4 [‐10.80, 6.00] |
| 1.2 NSBB 1x starting dose | 5 | 393 | Mean Difference (Fixed, 95% CI) | ‐5.27 [‐8.44, ‐2.11] |
| 1.3 NSBB 2x starting dose | 15 | 768 | Mean Difference (Fixed, 95% CI) | ‐11.72 [‐14.00, ‐9.43] |
| 1.4 NSBB 4x starting dose | 7 | 109 | Mean Difference (Fixed, 95% CI) | ‐20.83 [‐25.12, ‐16.54] |
| 1.5 NSBB 8x starting dose | 2 | 205 | Mean Difference (Fixed, 95% CI) | ‐4.31 [‐9.60, 0.97] |
| 2 Diastolic blood pressure Show forest plot | 22 | Mean Difference (Fixed, 95% CI) | Subtotals only | |
| 2.1 NSBB 0.5x starting dose | 1 | 155 | Mean Difference (Fixed, 95% CI) | ‐2.9 [‐8.23, 2.43] |
| 2.2 NSBB 1x starting dose | 5 | 393 | Mean Difference (Fixed, 95% CI) | ‐3.59 [‐5.37, ‐1.81] |
| 2.3 NSBB 2x starting dose | 15 | 768 | Mean Difference (Fixed, 95% CI) | ‐8.44 [‐9.83, ‐7.05] |
| 2.4 NSBB 4x starting dose | 7 | 109 | Mean Difference (Fixed, 95% CI) | ‐14.17 [‐16.98, ‐11.37] |
| 2.5 NSBB 8x starting dose | 2 | 205 | Mean Difference (Fixed, 95% CI) | ‐3.03 [‐6.06, 0.00] |
| 3 Heart rate Show forest plot | 17 | Mean Difference (Fixed, 95% CI) | Subtotals only | |
| 3.1 NSBB 0.5x starting dose | 1 | 155 | Mean Difference (Fixed, 95% CI) | ‐1.2 [‐12.53, 10.13] |
| 3.2 NSBB 1x starting dose | 4 | 367 | Mean Difference (Fixed, 95% CI) | ‐8.76 [‐11.99, ‐5.53] |
| 3.3 NSBB 2x starting dose | 12 | 683 | Mean Difference (Fixed, 95% CI) | ‐12.56 [‐14.17, ‐10.95] |
| 3.4 NSBB 4x starting dose | 6 | 95 | Mean Difference (Fixed, 95% CI) | ‐18.52 [‐21.68, ‐15.36] |
| 4 Pulse pressure Show forest plot | 22 | Mean Difference (Fixed, 95% CI) | Subtotals only | |
| 4.1 NSBB 0.5x starting dose | 1 | 155 | Mean Difference (Fixed, 95% CI) | 0.5 [‐9.78, 10.78] |
| 4.2 NSBB 1x starting dose | 5 | 393 | Mean Difference (Fixed, 95% CI) | ‐1.46 [‐4.56, 1.64] |
| 4.3 NSBB 2x starting dose | 15 | 768 | Mean Difference (Fixed, 95% CI) | ‐2.20 [‐3.93, ‐0.47] |
| 4.4 NSBB 4x starting dose | 7 | 109 | Mean Difference (Fixed, 95% CI) | ‐3.17 [‐6.61, 0.28] |
| 4.5 NSBB 8x starting dose | 2 | 205 | Mean Difference (Fixed, 95% CI) | ‐2.29 [‐8.42, 3.83] |
| 5 Withdrawal due to adverse effects Show forest plot | 2 | 729 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.84 [0.38, 1.82] |
| 5.1 Propranolol vs. placebo | 1 | 427 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.88 [0.34, 2.31] |
| 5.2 Penbutolol vs. placebo | 1 | 302 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.76 [0.20, 2.85] |
| 6 Combined 1x and 2x starting dose estimates Show forest plot | 18 | Mean Difference (Fixed, 95% CI) | Subtotals only | |
| 6.1 Systolic blood pressure | 16 | 948 | Mean Difference (Fixed, 95% CI) | ‐9.50 [‐10.91, ‐8.09] |
| 6.2 Diastolic blood pressure | 16 | 948 | Mean Difference (Fixed, 95% CI) | ‐6.60 [‐7.43, ‐5.76] |
| 6.3 Heart rate | 13 | 864 | Mean Difference (Fixed, 95% CI) | ‐11.80 [‐12.90, ‐10.71] |
| 6.4 Pulse pressure | 16 | 948 | Mean Difference (Fixed, 95% CI) | ‐2.02 [‐3.17, ‐0.87] |
