Vol 22, No 6 (2015)
Original articles
Published online: 2015-12-30

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Influence of beta-blockers on endothelial function: A meta-analysis of randomized controlled trials

Michał Peller, Krzysztof Ozierański, Pawel Balsam, Marcin Grabowski, Krzysztof J. Filipiak, Grzegorz Opolski
DOI: 10.5603/CJ.a2015.0042
Pubmed: 26202651
Cardiol J 2015;22(6):708-716.


Background: Endothelial dysfunction (ED) frequently precedes cardiovascular diseases (CVD) and is a well-established risk factor of major adverse cardiac events. Beta-blockers are the fundamental drugs used in CVD treatment.

Methods: A systematic literature search for randomized controlled trials investigating influence of beta-blockers on endothelial function assessed by flow-mediated dilation (FMD) was performed in the PubMed and Cochrane Databases.

Results: Sixteen full-text studies involving a total of 1,273 patients were included in the final analysis. The mean age of participating patients ranged from 44.9 to 63.2 years, the follow-up duration from 1 to 12 months. The comparison of FMD change between the beta-blockers and placebo groups showed a statistically significant effect of beta-blockers on endothelial function (mean difference [MD] 0.83; 95% confidence interval [CI] 0.11–1.55; p = 0.02). Third generation beta-blockers improved FMD in a statistically significant manner compared with second generation beta-blockers (MD 1.65; 95% CI 0.17–3.11; p = 0.03). Beta-blockers gave an FMD change similar to that obtained with angiotensin receptor blockers (ARB), calcium channel blockers (CCB) or hydrochlorothiazide. The FMD value in the beta-blocker group was significantly lower compared with the group treated with angiotensin converting enzyme inhibitors (ACEI) (MD –0.79; 95% CI –1.37–(–0.21); p = 0.008) and higher than in the ivabradine group (1.6 ± 3.61 vs –0.3 ± 1.66; p = 0.02).

Conclusions: Beta-blockers improve the endothelial function compared with placebo. More­over, third generation beta-blockers improve FMD values significantly better than the second generation ones. Beta-blockers had similar effect on endothelial function as did ARB, CCB or diuretics. However, the beneficial effect of beta-blockers was lower when confronted with ACEI.