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Table 1 Recommendations for beta blockers in older people with hypertension

From: Effectiveness and safety of beta blockers in the management of hypertension in older adults: a systematic review to help reduce inappropriate prescribing

Recommendation Strength of the recommendation Quality of the evidence Type of evidence
It is suggested to discontinue the beta blocker or change it to another antihypertensive drug (unless another indication for beta blockers exists), because beta blockers may increase the risk of stroke and other composite cardiovascular outcomes compared to other antihypertensive agents while not revealing any benefit regarding cardiovascular outcomes or mortality compared to placebo for adults >60 years. Strong Low
Downgraded for indirectness because only one meta-analysis and one RCT were focused on older people
2 Cochrane reviews [17, 49], 2 meta-analyses [33, 54], 2 recommendation papers from the Canadian Hypertension Education Program [51, 52], and 1 RCT [35]
It is suggested to discontinue atenolol for the management of hypertension because it appears to be less effective than other antihypertensives in reducing cardiovascular events, and to have a higher risk of adverse events. Strong Low
Downgraded for indirectness because only one RCT was focused on older people
2 Cochrane reviews [17, 50] and 2 RCTs [35]
It is suggested to discontinue beta blockers as monotherapy for the management of hypertension because it may be inferior to other antihypertensives in preventing stroke, and not to have any benefits in decreasing the rates of cardiovascular events. This recommendation does not apply if the patient has other indications for beta blockers (heart failure, arrhythmia, previous myocardial infarction, angina pectoris). Strong Low
Downgraded for indirectness because only the meta-analysis included a subgroup analysis in older people
1 Cochrane review [17], 1 meta-analysis [33] and 1 evidence based guideline [38]
  1. Legend: RCT randomized controlled trial