Beta-blockade is linked to substantially better COPD outcomes: nationwide study

  • EClinicalMedicine

  • curated by Jenny Blair, MD
  • Clinical Essentials
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Takeaway

  • Use of beta-blockers vs other antihypertensives was associated with markedly lower rates of COPD hospitalization and COPD mortality in a Danish population-based study.
  • Link seen with both selective and nonselective beta-blockers and after excluding early years of follow-up, mitigating possible “healthy user” bias.
  • Randomized clinical trial needed.

Why this matters

  • Beta-blockers can cause bronchoconstriction.
  • In patients with COPD, studies have linked beta-blockers to worsened symptoms and lung function but to fewer exacerbations and post-myocardial infarction deaths.

Key results

  • Users of beta-blockers vs other, adjusted HRs (95% CIs) for COPD-related:
    • Hospitalization: 0.80 (0.79-0.82).
    • Hospitalization after first 5 years of follow-up: 0.85 (0.83-0.87).
    • Death: 0.56 (0.53-0.59).
    • Death after first 5 years of follow-up: 0.72 (0.67-0.78).
  • Similar decreased risk of hospitalization:
    • With selective vs nonselective beta-blockers.
    • After stratifying for age, sex.
    • Upon subgroup analyses based on comorbidities, except diabetes.

Study design

  • Analysis of Danish National Patient Registry, linked prescription, death registries.
  • Authors followed general population without COPD hospitalization history from 1995 to 2015, including:
    • 301,542 new beta-blocker users, and
    • 1,000,633 new users of non-beta-blocker antihypertensives.
  • Outcomes: COPD admissions; COPD death.
  • Funding: Danish nonprofits.

Limitations

  • No smoking data.
  • May not generalize to other populations.

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