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April 14, 1989

β-Blockers and Primary Prevention of Coronary Heart Disease in Patients With High Blood Pressure

JAMA. 1989;261(14):2087-2094. doi:10.1001/jama.1989.03420140089033

We conducted a population-based, case-control study to determine whether β-blockers, used for the treatment of hypertension, prevent first events of coronary heart disease. Cases were patients who had high blood pressure treated with medicines and who presented in 1982 to 1984 with angina or fatal or nonfatal myocardial infarction. Controls were a probability sample of health maintenance organization patients with pharmacologically treated hypertension and free of coronary heart disease. Blinded to case-control status, we reviewed the medical records of the 248 cases and 737 controls. The health maintenance organization's computerized pharmacy database was used to ascertain the use of β-blockers. Fewer cases than controls were taking β-blockers. This difference was confined to those with nonfatal infarctions. After adjustment for confounding, the estimated relative risk was 0.62 (95% confidence interval, 0.39 to 0.99). Higher doses of β-blockers conferred greater protection. We conclude that β-blockers may prevent first events of nonfatal myocardial infarction in patients with high blood pressure.

(JAMA. 1989;261:2087-2094)