USE OF BETA-BLOCKERS IN HYPERTENSIVE OVERWEIGHT AND OBESE PATIENTS WITHOUT COMPELLING INDICATIONS

PURPOSE: Beta-blockers (BBs) cause weight gain and make weight loss more difficult. Clinicians should limit the use of BBs in overweight and obese patients to those who have compelling indications for the medications. Uncomplicated hypertension is no longer considered a compelling indication for BBs. The purpose of this study was to determine the prevalence of BB prescription without compelling indication among hypertensive overweight and obese patients in our academic practice. METHODS: We queried our clinical data warehouse containing data on over 53,000 outpatients to identify overweight (body mass index [BMI] 25.0-29.9) and obese (BMI ≥ 30.0) adults with hypertension who were on a BB. We determined the proportion of patients who had no compelling indication for BBs, as defined by JNC-7 guidelines and expert opinion. The diagnosis of hypertension and compelling indications for BBs were documented in structured fields or electronic billing. We manually reviewed the free text in the clinical notes in a random 10% sample of those without compelling indications to estimate the accuracy of our queries. RESULTS: Thirty-seven percent (145/396) of overweight and 35.6% (206/578) obese adults with hypertension on a BB had no compelling indications for the medication. In the manual review, 19% (7/36) of patients had compelling reasons for BBs mentioned in the free text of the notes which were not detected by our query. Using this rate of undetected compelling indications for BBs to adjust our estimates, approximately 29-30% of hypertensive overweight and obese patients on BBs appear to have no compelling indications for these medications. CONCLUSION: Our systematic review of medical records suggests that BBs are commonly prescribed to hypertensive overweight or obese adults without a compelling indication, even though BBs cause weight gain and make weight loss more difficult. Weight-neutral antihypertensive agents are preferred for overweight and obese patients when possible. Methods to monitor and improve guideline compliance are needed, even in academic settings.