In a recent article in Hypertension, Bugiardini et al explored whether the effect of beta-blockers differed according to gender in patients with hypertension and no history of cardiovascular disease. The study included 13,764 patients with acute coronary syndrome, based on records from the International Survey of Acute Coronary Syndromes archives, which collected data from 41 centers in 12 European countries. The data were obtained from 2,590 patients (954 women and 1,636 men) with hypertension who were previously treated with beta-blockers. The primary outcome measure for this study was the prevalence of heart failure according to Killip class classification and subsidiary analyses were conducted to estimate the correlation between heart failure and all-cause mortality at 30 days.

In the study, no considerable variances were noted in baseline characteristics and medication use between the 954 women and 1,636 men who were on beta-blocker therapy or between the 3,132 women and 8,042 men who did not initiate beta-blockers before the index event. The average age of people who had previously used beta-blockers was 65.1 ± 11.2 years for women and 65.0 ± 11.6 years for men. Among nonusers of beta-blockers, the average age was 60.3 ± 12.3 years for women and 60.7 ± 11.9 years for men. The study also found that having a history of diabetes mellitus, hypercholesterolemia, or chronic kidney disease was more common in women compared with men, and fewer women were current or former smokers. The average systolic blood pressure at hospital presentation was slightly greater (<1 mmHg) among women than among men.

Among patients who had taken beta-blockers prior to admission, the researchers found an absolute variation of 4.6% between women and men in the rate of heart failure (Killip ≥2) at hospital presentation (21.3% vs. 16.7%; relative risk ratio, 1.35; 95% CI, 1.10-1.65). The rate of heart failure was analogous in women and men who had not received beta-blockers (17.2% vs. 16.1%, respectively; relative risk ratio, 1.09; 95% CI, 0.97-1.21). The test of interaction identified a considerable (P = .034) connection between gender and beta-blocker therapy. Moreover, heart failure was a strong predictor of mortality at 30 days in women (odds ratio, 7.54; 95% CI, 5.78-9.83) and men (odds ratio, 9.62; 95% CI, 7.67-12.07). Researchers also noted that other factors impacting 30-day mortality included age, chronic kidney disease, and ST-segment shifts in anterior multivessel disease.

The authors indicated that limitations to the analysis included the observational study design and the inability to standardize determination of Killip class as it reflects clinical practice. The authors also wrote “Our findings raise strong concern about the appropriate role of beta-blockers in the therapy of hypertension in women with no prior history of cardiovascular diseases. Beta-blocker use may be an acute precipitant of heart failure in women presenting with incident acute coronary syndrome as first manifestation of CHD.” 
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