PharmacoEconomics

, Volume 8, Issue 6, pp 513–523 | Cite as

Selective versus Nonselective β Adrenoceptor Antagonists in Hypertension

  • Luc M. A. B. Van Bortell
  • Andre J. H. A. Ament
Review Article

Abstract

The application of cost-effectiveness methodology is particularly important in widespread diseases such as hypertension. However, because prospective costeffectiveness analyses comparing different antihypertensive drugs are not currently available, differences in the cost effectiveness of these drugs can only be estimated. The purpose of this review is to estimate and compare the costs of drug therapy with selective and nonselective β adrenoceptor antagonists in hypertension.

The global costs of antihypertensive treatment are largely determined by drug costs. In most countries, drug costs do not appear to vary substantially between β1-selective and nonselective β-blockers.

The adverse sequelae of hypertension include stroke, myocardial infarction, cardiac hypertrophy and renal failure. There are no obvious differences in effect on stroke and cardiac hypertrophy between β1-selective and nonselective β-blockers. However, compared with β1-selective antagonists, nonselective drugs might be less effective in preventing myocardial infarction in smokers and may impair renal function in patients with both increased peripheral resistance and declining cardiac output.

There is a clear difference between β1-selective and nonselective β-blockers on quality-of-life (QOL) perception. During treatment with nonselective β-blockers, QOL perception is lower than during treatment with β1-selective drugs. Preservation of quality of life during long term antihypertensive treatment deserves considerable weight in economic analyses. Consequently, the more favourable effects of β1-seIective agents on quality of life may outweigh the possible higher costs of these drugs, and suggest that β1-selective agents may be more cost effective than nonselective β-blockers.

Keywords

Propranolol Atenolol Cardiac Hypertrophy Betaxolol Cilazapril 

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References

  1. 1.
    1993 Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure. The fifth report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure. Arch Intern Med 1993: 153: 154–83CrossRefGoogle Scholar
  2. 2.
    Williams GH, Braunwald E. Hypertension. In: Braunwald E, Isselbacher KJ, Petersdorf RG, et al., editors. Harrison’s principles of internal medicine. 11th ed. New York: McGraw-Hill, 1987: 1024–37Google Scholar
  3. 3.
    Pickering G. High blood pressure. 2nd ed. London: J&A Churchill Ltd, 1968Google Scholar
  4. 4.
    Kannel WB. Hypertension and the risk for cardiovascular disease. In: Laragh JH, Brenner BM, editors. Hypertension: pathophysiology, diagnosis and management. New York: Raven Press, 1990: 101–17Google Scholar
  5. 5.
    Bulpitt CJ, Beevers DG, Butler A, et al. The survival of treated hypertensive patients and their causes of death: a report from the DHHS hypertensive care computing project (DHCCP). J Hypertens 1986; 4: 93–9PubMedCrossRefGoogle Scholar
  6. 6.
    Sleight P. Hypertension. In: Weatherall DJ, Ledingham JGG, Warrell DA, editors. Oxford textbook of medicine. Oxford: Oxford Medical Publications, 1985: 13.258–13.278Google Scholar
  7. 7.
    Shulman N. Economic issues relating to access to medications. Cardiovasc Clin 1991; 21: 75–82PubMedGoogle Scholar
  8. 8.
    Johannesson M, Borgquist L, Jonsson B. The costs of treating hypertension in Sweden: an empirical investigation in primary health care. Scand J Prim Health Care 1991; 9: 155–60PubMedCrossRefGoogle Scholar
  9. 9.
    Wilhelmsen L. Outcome of blood pressure control. Qual Assur Health Care 1990; 2: 271–8PubMedCrossRefGoogle Scholar
  10. 10.
    1988 Joint National Committee. The 1988 report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure. Arch Intern Med 1988; 148: 1023–38CrossRefGoogle Scholar
  11. 11.
    Johannesson M, Dahlöf B, Lindholm L, et al. The cost-effectiveness of treating hypertension in elderly people–an analysis of the Swedish trial in old patients with hypertension (STOP Hypertension). J Int Med 1993; 234: 317–23CrossRefGoogle Scholar
  12. 12.
    Yedinak KC. Formulary considerations in selection of β-blockers. PharmacoEconomics 1993; 4: 104–21PubMedCrossRefGoogle Scholar
  13. 13.
    Farmacotherapeutisch Kompas. van der Kuy A, editor. Centrale Medisch Pharmaceutische Commissie van de Ziekenfondsraad. Amstelveen (The Netherlands): Ziekenfondsraad, 1993: 158–9Google Scholar
  14. 14.
    Drummond MF, Stoddart GL, Torrance Gw. Methods for the economic evaluation of health care programmes. Oxford: Oxford University Press, 1987Google Scholar
  15. 15.
    Weinstein MC. Principles of cost-effective resource allocation in health care organizations. Int J Technol Assess Health Care 1990; 6: 93–107PubMedCrossRefGoogle Scholar
  16. 16.
    Luce BR, Elixhauser A. Estimating costs in the economic evaluation of medical technologies. Int J Technol Assess Health Care 1990; 6: 57–77PubMedCrossRefGoogle Scholar
  17. 17.
    Wester PO, Asplund K, Eriksson S, et al. Economics. In: Magnusson S, Werkö L, editors. Stroke, Stockholm: Swedish Council on Technology Assessment in Health Care, 1993: 94–102Google Scholar
  18. 18.
    Koopmanschap MA, van Roijen L, Bonneux L. Kosten van ziekten in Nederland. Rotterdam: Instituut Maatschappelijke Gezondheidszorg, iMTA, Erasmus Universiteit, 1991Google Scholar
  19. 19.
    Collins R, Peto R, MacMahon S, et al. Blood pressure, stroke, and coronary heart disease. Part 2. Short-term reductions in blood pressure: overview of randomised drug trials in their epidemiological context. Lancet 1990; 335: 827–38Google Scholar
  20. 20.
    Petrovitch H, Vogt TM, Berge KG. Isolated systolic hypertension: lowering the risk of stroke in older patients. Geriatrics 1992; 47: 30–8PubMedGoogle Scholar
  21. 21.
    Rutan GH, Kuller LH, Neaton JD, et al. Mortality associated with diastolic hypertension and isolated systolic hypertension among men screened for Multiple Risk Factor Intervention Trial. Circulation 1988; 77: 504–14PubMedCrossRefGoogle Scholar
  22. 22.
    Medical Research Council Working Party. MRC trial of treatment of mild hypertension: principal results. BMJ 1985; 29: 97–104Google Scholar
  23. 23.
    McNeil JJ. Analysis of antihypertensive treatment outcome and stroke. Clin Exp Hypertens 1989; 11: 761–77CrossRefGoogle Scholar
  24. 24.
    Laragh JH. Strategies in choosing therapy for hypertension. In: Kaplan NM, Brenner BM, Laragh JH, editors. New therapeutic strategies in hypertension. New York: Raven Press, 1989: 141–69Google Scholar
  25. 25.
    Brunner HR, Ménard J, Waeber B, et al. Treating the individual hypertensive patient: considerations on dose, sequential monotherapy and drug combinations. J Hypertens 1990; 8: 3–11PubMedCrossRefGoogle Scholar
  26. 26.
    Frishman WH. β-Adrenergic blockers. Med Clin North Am 1988; 72: 37–81PubMedGoogle Scholar
  27. 27.
    Edelson J, Weinstein M, Tosteson A, et al. Long-term cost-effectiveness of various initial monotherapies for mild to moderate hypertension. JAMA 1990; 263: 407–13PubMedCrossRefGoogle Scholar
  28. 28.
    Boissel JP, Leizorovicz A, Picolet H, et al. Secondary prevention after high-risk acute myocardial infarction with low-dose acebutolol. Am J Cardiol 1990; 66: 251–60PubMedCrossRefGoogle Scholar
  29. 29.
    Yusuf S, Peto R, Lewis J, et al. Beta-blockade during and after myocardial infarction: an overview of the randomized trials. Prog Cardiovasc Dis 1985; 27: 335–71PubMedCrossRefGoogle Scholar
  30. 30.
    Cruickshank JM, Pennert K, Sorman AE, et al. Low mortality from all causes, including myocardial infarction, in well-controlled hypertensives treated with a beta-blocker plus other antihypertensives. J Hypertens 1987; 5: 489–98PubMedGoogle Scholar
  31. 31.
    Norwegian Study Group. Timolol-induced reduction in mortality and reinfarction in patients surviving acute myocardial infarction. N Engl J Med 1981; 304: 801–7CrossRefGoogle Scholar
  32. 32.
    Beta-Blocker Heart Attack Trial Research Group. A randomized trial of propranolol in patients with acute myocardial infarction: 1. Mortality results. JAMA 1982; 247: 1707–14CrossRefGoogle Scholar
  33. 33.
    Olsson G, Lubsen J, van Es G, et al. Quality of life after myocardial infarction: effect of long-term metoprolol on mortality and morbidity. BMJ 1986; 292: 1491–3PubMedCrossRefGoogle Scholar
  34. 34.
    Wikstrand J, Warnold I, Olsson G, et al. Primary prevention with metoprolol in patients with hypertension: mortality results from the MAPHY study. JAMA 1988; 259: 1976–82PubMedCrossRefGoogle Scholar
  35. 35.
    Wikstrand J. Reducing the risk for coronary heart disease and stroke in hypertensives: comments on mechanisms for coronary protection and quality of life. J Clin Pharm Ther 1992; 17: 9–29PubMedCrossRefGoogle Scholar
  36. 36.
    Cruickshank JM. β-Blockers and primary prevention revisited. Cardiovasc Rev Rep 1990; 11: 10–6Google Scholar
  37. 37.
    Fitzgerald JD. By what means might beta-blockers prolong life after acute myocardial infarction? Eur Heart J 1987; 8: 945–51PubMedGoogle Scholar
  38. 38.
    Muller JE, Stone PH, Turi ZG, et al. Circadian variation in the frequency of onset of acute myocardial infarction. N Engl J Med 1985; 313: 1315–22PubMedCrossRefGoogle Scholar
  39. 39.
    Fox FM, Chopra MP, Ponal RW, et al. Long-term beta-blockade: possible protection from myocardial infarction. BMJ 1975; 1: 117–9PubMedCrossRefGoogle Scholar
  40. 40.
    Coope J, Warrender TS. Randomised trial of hypertension of elderly patients in primary care. BMJ 1986; 293: 1145–51PubMedCrossRefGoogle Scholar
  41. 41.
    Medical Research Council Working Party. Medical Research Council trial of treatment of hypertension in older adults: principal results. BMJ 1992; 304: 405–12CrossRefGoogle Scholar
  42. 42.
    SHEP Cooperative Research Group. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension: final results of the Systolic Hypertension in the Elderly Program (SHEP). JAMA 1991; 265: 3255–64CrossRefGoogle Scholar
  43. 43.
    Messerli FH. Left ventricular hypertrophy, arterial hypertension and sudden death. J Hypertens 1990; 8 Suppl. 7: 181S–5SGoogle Scholar
  44. 44.
    Koren MJ, Ulin RJ, Laragh JH, et al. Reduction of left ventricular mass during treatment of essential hypertension is associated with improved prognosis. Am J Hypertens 1991; 4: 1A–2AGoogle Scholar
  45. 45.
    Dahlöf B, Pennen K, Hansson L. Reversal of left ventricular hypertrophy in hypertensive patients: a metaanalysis of 109 treatment studies. Am J Hypertens 1992; 5: 95–110PubMedGoogle Scholar
  46. 46.
    Fagard R, Lijnen P, Staessen J, et al. Mechanical and other factors relating to left ventricular hypertrophy. Blood Press 1994; 3 Suppl. 1: 5–10Google Scholar
  47. 47.
    Giles T. Antihypertensive therapy and cardiovascular risk: are all antihypertensives equal? Hypertension 1992; 19 Suppl. 1: 1124–9Google Scholar
  48. 48.
    Whelton PK, Klag MJ. Hypertension as a risk factor for renal disease: review of clinical and epidemiological evidence. Hypertension 1989; 13 Suppl. 1: 119–27Google Scholar
  49. 49.
    Weir MR, Hise MK. Hypertensive renal damage. Cardiovasc Clin 1991; 21: 115–32PubMedGoogle Scholar
  50. 50.
    Schmieder R, Friedrich G, Neus H, et al. The influence of beta-blockers on cardiovascular reactivity and type ‘A’ behaviour pattern in hypertensives. Psychosom Med 1983; 45: 417–23PubMedGoogle Scholar
  51. 51.
    Krantz DS, Durel LA, Davia JE, et al. Propranolol medication among coronary patients: relationship to type A behaviour and cardiovascular response. J Human Stress 1982; 8: 4–12PubMedCrossRefGoogle Scholar
  52. 52.
    Friedman M, Thoresen CE, Gill JJ. Alteration of type ‘A’ behaviour and its effect on cardiac recurrences in post myocardial infarction patients: summary results of the recurrent coronary prevention project. Am Heart J 1986; 112: 653–65PubMedCrossRefGoogle Scholar
  53. 53.
    Lithell H. Metabolic effects of antihypertensive drugs interacting with the sympathetic nervous system. Am Heart J 1992; 13 Suppl. A: 53–7Google Scholar
  54. 54.
    Wright AD, Barber SG, Kendall MJ, et al. Beta-adrenoceptor blocking drugs and blood sugar control in diabetes mellitus. BMJ 1979; 1: 159–61PubMedCrossRefGoogle Scholar
  55. 55.
    Northcote RJ. Metabolic parameters: how important are pharmacologically-induced changes? J Hypertens 1991; 9 Suppl.7: S21–5CrossRefGoogle Scholar
  56. 56.
    Cruickshank JM, Smith Jc. The beta-receptor, atheroma and cardiovascular damage. Pharmacol Ther 1989; 42: 385–404PubMedCrossRefGoogle Scholar
  57. 57.
    Australian and Swedish Pindolol Study Group. The effect of pindolol on two years mortality after complicated myocardial infarction. Eur Heart J 1983; 4: 367–75Google Scholar
  58. 58.
    European Infarction Study Group. European Infarction Study (EIS): a secondary prevention study with slow release oxprenolol after myocardial infarction: morbidity and mortality. Eur Heart J 1984; 5: 189–202Google Scholar
  59. 59.
    Pardell H, Armario P, Hernandez R. Progress in the 1980s and new directions in the 1990s with hypertension management: from stepped-care approach to individualized programme in hypertension treatment and control. Drugs 1992; 43: 1–5PubMedCrossRefGoogle Scholar
  60. 60.
    Marmot MG, Poulter NR. Primary prevention of stroke. Lancet 1992; 339: 344–7PubMedCrossRefGoogle Scholar
  61. 61.
    Haynes RB, Taylor DW, Sackett DL, et al. Can simple clinical measurements detect patient noncompliance? Hypertension 1980; 2: 757–64PubMedCrossRefGoogle Scholar
  62. 62.
    National Heart, Lung, and Blood Institute Working Group. Management of patient compliance in the treatment of hypertension. Hypertension 1982; 4: 415–23CrossRefGoogle Scholar
  63. 63.
    Urquhart J. Patient compliance as an explanatory variable in four selected cardiovascular studies. In: Cramer JA, Spilker B, editors. Patient compliance in medical practice and clinical trials. New York: Raven Press, 1991Google Scholar
  64. 64.
    Eisen SA, Miller OK, Woodward RS, et al. The effect of prescribed daily dose frequency on patient medication compliance. Arch Intern Med 1990; 150: 1881–4PubMedCrossRefGoogle Scholar
  65. 65.
    Winickoff RN, Murphy PK. The persistent problem of poor blood pressure control. Arch Intern Med 1987; 147: 1393–6PubMedCrossRefGoogle Scholar
  66. 66.
    Inui TS, Carter WB, Pecoraro RE. Screening for noncompliance among patients with hypertension: is self-report the best available measure? Med Care 1981; 19: 1061–4PubMedCrossRefGoogle Scholar
  67. 67.
    Widmer RB, Cadoret RJ, Troughton E. Compliance characteristics of 291 hypertensive patients from a rural midwest area. J Fam Pract 1983; 17: 619–25PubMedGoogle Scholar
  68. 68.
    Haynes RB, Gibson ES, Taylor DW, et al. Process vs outcome in hypertension: a positive result. Circulation 1982; 65: 28–33PubMedCrossRefGoogle Scholar
  69. 69.
    Williams GH. Quality of life and its impact on hypertensive patients. Am J Med 1987; 82: 98–105PubMedCrossRefGoogle Scholar
  70. 70.
    Wenger NK, Furberg CD. Cardiovascular disorders. In: Spilker B, editor. Quality of life assessments in clinical trials. New York: Raven Press, 1990: 335–45Google Scholar
  71. 71.
    Zachariah PK. Quality oflife with antihypertensive medication. J Hypertens 1987; 5 Suppl. 4: 105S–1OSCrossRefGoogle Scholar
  72. 72.
    Wassertheil-Smoller S, Blaufox D, Oberman A, et al. Effect of antihypertensives on sexual function and quality of life: the TAIM study. Ann Intern Med 1991; 114: 613–20PubMedGoogle Scholar
  73. 73.
    Deyo RA. The quality of life, research, and care. Ann Intern Med 1991; 114: 695–6PubMedGoogle Scholar
  74. 74.
    Jaeschke R, Guyatt GH. How to develop and validate a new quality of life instrument. In: Spilker B, editor. Quality of life assessments in clinical trials. New York: Raven Press, 1990: 47–57Google Scholar
  75. 75.
    Fletcher AE, Bulpitt CJ, Hawkins CM, et al. Quality of life on antihypertensive therapy: a randomized double-blind trial of captopril and atenolol. J Hypertens 1990; 8: 463–6PubMedCrossRefGoogle Scholar
  76. 76.
    Van Bonel LMAB, Breed JGS, Joosten J, et al. Nebivolol in hypertension: a double blind placebo-controlled multicentre study assessing its antihypertensive efficacy and impact on quality of life. J Cardiovasc Pharmacol 1993; 21: 856–62CrossRefGoogle Scholar
  77. 77.
    Hollenberg NK, Testa M, Williams GH. Quality of life as a therapeutic end-point: an analysis of therapeutic trials in hypertension. Drug Saf 1991; 6: 83–93PubMedCrossRefGoogle Scholar
  78. 78.
    Croog SH, Levine S, Testa MA, et al. The effects of antihypertensive therapy on the quality of life. N Engl J Med 1986; 314: 1657–64PubMedCrossRefGoogle Scholar
  79. 79.
    Steiner SS, Friedhoff AJ, Wilson BL, et al. Antihypertensive therapy and quality of life: a comparison of atenolol, captopril, enalapril and propranolol. J Hum Hypertens 1990; 4: 217–25PubMedGoogle Scholar
  80. 80.
    Herrick AL, Waller PC, Berkin KE, et al. Comparison of enalapril and atenolol in mild to moderate hypertension. Am J Med 1989; 86: 421–6PubMedCrossRefGoogle Scholar
  81. 81.
    Fletcher AE, Bulpitt CJ, Chase DM, et al. Quality of life with three antihypertensive treatments: cilazapril, atenolol, nifedipine. Hypertension 1992; 19: 499–507PubMedCrossRefGoogle Scholar
  82. 82.
    Breed JGS, Ciampricotti R, Tromp GP, et al. Quality of life perception during antihypertensive treatment: a comparative study of bisoprolol and enalapril. J Cardiovasc Pharmacol 1992; 20: 750–5PubMedGoogle Scholar
  83. 83.
    Walle PO, Westergren G, Dimenäs E, et al. Effects of 100 mg of controlled-release metoprolol and 100 mg of atenolol on blood pressure, central nervous system-related symptoms, and general well-being. J Clin Pharmacol 1994; 34: 742–7PubMedGoogle Scholar
  84. 84.
    Wiklund I. Quality of life and cost-effectiveness in the treatment of hypertension. J Clin Pharm Ther 1994; 19: 81–7PubMedCrossRefGoogle Scholar
  85. 85.
    Dahlöf C, Dimenäs E, Kendall M, et al. Quality of life in cardiovascular diseases: emphasis on beta-blocker treatment. Circulation 1991; 84 Suppl. 6: VII08–18Google Scholar
  86. 86.
    Weinstein M, Stason W. Hypertension–a policy perspective. Cambridge (MA): Harvard University Press, 1976Google Scholar
  87. 87.
    Fletcher AE, Bulpitt CJ. Pharmacoeconomic evaluation of risk factors for cardiovascular disease: an epidemiological perspective. PharmacoEconomics 1992; 1: 33–44PubMedCrossRefGoogle Scholar
  88. 88.
    Johannesson M, Jönsson B. A review of cost-effectiveness analyses of hypertension treatment. PharmacoEconomics 1992; 1: 250–64PubMedCrossRefGoogle Scholar
  89. 89.
    Lindgren B, Persson U. The cost-effectiveness of a new antihypertensive drug, doxazosin. Curr Ther Res 1989; 45: 738–60Google Scholar
  90. 90.
    Kawachi I, Malcolm L. The cost-effectiveness of treating mild-to-moderate hypenension: a reappraisal. J Hypertens 1991; 9: 199–208PubMedCrossRefGoogle Scholar
  91. 91.
    Blankenhorn DH, Kramsch DM. Reversal of atherosis and sclerosis. The two components of atherosclerosis. Circulation 1989; 79: 1–7Google Scholar

Copyright information

© Springer International Publishing AG 1995

Authors and Affiliations

  • Luc M. A. B. Van Bortell
    • 1
  • Andre J. H. A. Ament
    • 2
  1. 1.Department of Pharmacology, Cardiovascular Research InstituteUniversity of LimburgMaastrichtThe Netherlands
  2. 2.Department of Health Economics, Cardiovascular Research InstituteUniversity of LimburgMaastrichtThe Netherlands

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