Women prescribed beta blockers for hypertension who have no history of cardiovascular disease (CVD) have a 4.6% greater risk of heart failure than men when experiencing acute coronary syndrome, according to a study published in Hypertension.

Beta blockers act to reduce high blood pressure and are prescribed to treat patients with hypertension, which is the leading cause of CVD.

In order to assess any biological variations based on gender, the study authors assessed the effects of beta blockers among men and women with hypertension and no prior history of CVD who also have acute coronary syndromes. Any incidence of heart failure that followed were then recorded by the researchers to assess whether gender variation was present.

"Past research on the effects of beta blockers included a majority of participants who were men, so we sought to examine how sex/gender plays a role in the patient outcomes," said lead author Raffaele Bugiardini, MD, professor of cardiology at the University of Bologna, in a press release. "Women are historically underrepresented in most clinical studies on hypertension. It's important to include an equal split of male and female patients in future research, which could shed light on disparities and actionable treatments."

The study included data from 13,764 adults with hypertension and no prior history of cardiovascular disease across 12 European countries. Their patient information was pulled from the International Survey of Acute Coronary Syndromes Archives, the ISACS-TC, and the EMMACE-3X clinical registries during the period of October 2010 to July 2018.

Patients were then classified by gender and placed into 2 groups, comprised of 1 group who were taking beta blockers and a second group who were not.

The results demonstrated that women in the study had a 4.6% greater likelihood of heart failure than men when experiencing acute coronary syndrome symptoms. However, men and women not taking beta blockers had the same likelihood of heart failure.

Additionally, women with ST-segment elevation myocardial infarction (STEMI), a specific type of heart attack, had a 6.1% greater likelihood of heart failure over men with STEMI. STEMI is a heart attack in which a coronary artery is blocked, causing a majority of the heart muscle to not receive blood; the results can be very serious for patients.
"What we found presents a solid case for re-examination of the use of beta blocker therapy for women with hypertension. For women who have no history of cardiovascular disease and only hypertension, we think it is incredibly important for them to regulate their blood pressure through diet and exercise," Bugiardini said. "It's possible that the increased risk of heart failure for women is due to an interaction between hormone replacement therapy and beta blockers, though this information was not collected or tested in our study. This and other potential factors need to be investigated in more depth."

The researchers noted that a limitation of the study was that it was observational, resulting in some potential variance and a need for further confirmation. However, the researchers noted that the randomized controlled trial of beta-blocker therapy in patients with hypertension that would supply such data may not be ethical, as it would present risk and not benefit from the use of beta-blockers.

Women taking beta blockers for hypertension may have higher risk of heart failure with acute coronary syndrome. American Heart Association; July 13, 2020. eurekalert.org/pub_releases/2020-07/aha-wtb070820.php. Accessed August 19, 2020.