Prior β-Blocker Use May Lead to Higher Risk for Heart Failure in Women With New-Onset CHD

Woman with chest pain
Elderly woman having chest pains or heart attack in the park
Women who had previously taken β-blockers for hypertension were found to be at increased risk for heart failure in new-onset coronary heart disease.

Women who had previously taken β-blockers for hypertension were found to be at increased risk for heart failure in new-onset coronary heart disease (CHD), according to a study published in Hypertension.

The investigators sought to determine whether the effect of β‐blockers varied according to gender in patients with hypertension but no prior history of cardiovascular disease. They 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 of 2590 patients (37% women) with hypertension and previously treated with β-blockers were examined. The incidence of heart failure according to Killip class classification was the study’s primary outcome measure, and subsidiary analyses estimated the association between heart failure and all-cause mortality at 30 days.

No significant differences were observed in baseline characteristics and medication use between the 954 women and 1636 men who were on β-blocker therapy or between the 3132 women and 8042 men who did not initiate β-blockers before the index event. The mean age (±SD) of those who had previously used β-blockers was 65.1 ± 11.2 for women and 65.0 ± 11.6 for men. Among nonusers of β-blockers, the mean age was 60.3 ± 12.3 for women and 60.7 ± 11.9 for men. Women more frequently had a history of diabetes mellitus, hypercholesterolemia, and chronic kidney disease compared with men, and fewer women were current or former smokers. Mean systolic blood pressure at hospital presentation was slightly greater (<1 mm Hg) among women than in men.

Among patients who had taken β-blockers before admission, the researchers found an absolute difference 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 comparable in women and men who had not received β-blockers (17.2% vs 16.1%, respectively; relative risk ratio, 1.09; 95% CI, 0.97-1.21). The test of interaction identified a significant (P = .034) association between sex and β-blocker therapy.

Heart failure was predictive 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).

Limitations to the analysis include the observational study design and the inability to standardize determination of Killip class as it reflects clinical practice.

“Our findings raise strong concern about the appropriate role of β-blockers in the therapy of hypertension in women with no prior history of cardiovascular diseases,” noted the researchers. “β-blocker use may be an acute precipitant of heart failure in women presenting with incident acute coronary syndrome as first manifestation of CHD.”


Bugiardini R, Yoon J, Kedev S, et al. Prior beta-blocker therapy for hypertension and sex-based differences in heart failure among patients with incident coronary heart disease [published online July 13, 2020]. Hypertension. doi:10.1161/HYPERTENSIONAHA.120.15323