Drug Class Review Beta Adrenergic Blockers Final Report Update 4 July 2009 Update 3: September 2007 Update 2: May 2005 Update 1: September 2004 Original Report: September 2003 The literature on this topic is scanned periodically. The purpose of this report is to make available information regarding the comparative effectiveness and safety profiles of different drugs within pharmaceutical classes. Reports are not usage guidelines, nor should they be read as an endorsement of, or recommendation for, any particular drug, use, or approach. Oregon Health & Science University does not recommend or endorse any guideline or recommendation developed by users of these reports. Mark Helfand, MD, MPH Kim Peterson, MS Vivian Christensen, PhD Tracy Dana, MLS Sujata Thakurta, MPA:HA Drug Effectiveness Review Project Marian McDonagh, PharmD, Principal Investigator Oregon Evidence-based Practice Center Mark Helfand, MD, MPH, Director Oregon Health & Science University Copyright © 2009 by Oregon Health & Science University Portland, Oregon 97239. All rights reserved. Final Report Update 4 Drug Effectiveness Review Project TABLE OF CONTENTS INTRODUCTION .......................................................................................................................... 6 Purpose and Limitations of Evidence Reports........................................................................................ 8 Scope and Key Questions .................................................................................................................... 10 METHODS.................................................................................................................................. 11 Study Selection..................................................................................................................................... 11 Data Abstraction ................................................................................................................................... 13 Validity Assessment ............................................................................................................................. 13 Data Synthesis ..................................................................................................................................... 14 RESULTS ................................................................................................................................... 14 Overview............................................................................................................................................... 14 Summary of Findings............................................................................................................................ 16 Efficacy/effectiveness...................................................................................................................... 16 Key Question 1. Do beta blocker drugs differ in efficacy or effectiveness?.......................................... 19 Key Question 1a. For adult patients with hypertension, do beta blockers differ in efficacy or effectiveness?....................................................................................................................................... 19 Summary ......................................................................................................................................... 19 Detailed Assessment....................................................................................................................... 20 Primary or initial therapy ............................................................................................................... 20 Secondary treatment .................................................................................................................... 20 Quality of life ................................................................................................................................. 21 Key Question 1b. For adult patients with angina, do beta blockers differ in efficacy or effectiveness?....................................................................................................................................... 23 Summary ......................................................................................................................................... 23 Detailed Assessment....................................................................................................................... 23 Key Question 1c. For adult patients who have undergone coronary artery bypass grafting, do beta blockers differ in efficacy or effectiveness? .......................................................................................... 25 Key Question 1d. For adult patients with recent myocardial infarction, do beta blockers differ in efficacy or effectiveness? .................................................................................................................................. 25 Summary ......................................................................................................................................... 25 Head-to-Head Trials ........................................................................................................................ 26 Placebo-controlled Trials................................................................................................................. 26 Mortality ........................................................................................................................................ 27 Sudden death ............................................................................................................................... 29 Reinfarction................................................................................................................................... 29 Arrhythmias................................................................................................................................... 29 Withdrawals .................................................................................................................................. 30 Key Question 1e. For adult patients with heart failure, do beta blockers differ in efficacy or effectiveness?....................................................................................................................................... 31 Summary ......................................................................................................................................... 31 Detailed Assessment....................................................................................................................... 32 Placebo-controlled trials ............................................................................................................... 32 Mortality ................................................................................................................................... 32 Relation of mortality reduction to severity of heart failure........................................................ 33 New York Heart Association class........................................................................................... 38 Exercise capacity..................................................................................................................... 38 Quality of life............................................................................................................................ 39 Head-to-head trials ....................................................................................................................... 41 Mortality ................................................................................................................................... 42 Other outcomes ....................................................................................................................... 42 Key Question 1f. For adult patients with atrial arrhythmia, do beta blockers differ in efficacy or effectiveness?....................................................................................................................................... 43 Beta blockers Page 2 of 122 Final Report Update 4 Drug Effectiveness Review Project Key Question 1g. For adult patients with migraine, do beta blockers differ in efficacy or effectiveness?....................................................................................................................................... 44 Summary ......................................................................................................................................... 44 Detailed Assessment....................................................................................................................... 44 Head-to-head trials ....................................................................................................................... 44 Attack frequency...................................................................................................................... 45 Migraine days .......................................................................................................................... 45 Severity.................................................................................................................................... 45 Tablet consumption ................................................................................................................. 45 Subjective assessment...........................................................................................................