Beta-blockers are less beneficial than other antihypertensive drugs in the elderly with hypertension.

All elderly patients in Ontario, Canada (population over 3.5 million elderly) without co-morbidities who were first treated for hypertension with a beta-blocker were studied in this retrospective, population-based cohort study (1994-2002) to determine the characteristics of those prescribed beta-blockers.

Of the 194,761 patients in the cohort, 25,485 (13%) were prescribed a beta-blocker as their first antihypertensive agent.  On multivariate analysis, factors significantly associated with being prescribed a beta-blocker as first-line therapy included male sex (adjusted odds ratio (OR) 1.06 [95% CI 1.03-1.09] vs. women), younger age (adjusted OR 1.67 [95% CI 1.55-1.79] for patients aged 66-69 vs. those aged 85 or older), residence in a long-term care facility (adjusted OR 1.19 [95% CI 1.04-1.35] vs. living in the community) and lower socioeconomic status (adjusted OR 1.07 [95% CI 1.02-1.12], for lowest quintile vs. highest quintile).  Patients with diabetes were substantially less likely to be prescribed beta-blockers (adjusted OR 0.42 [95% CI 0.40-0.44]).

Greater efforts are required to educate physicians to select other drugs for initial therapy in older patients with uncomplicated hypertension.