Beta-blockers are effective in reducing peripheral blood pressure (pBP), but less effective than other drugs in reducing central blood pressure (cBP). It is controversial whether vasodilating (VB) beta-blockers may be more effective in reducing cBP compared to non-vasodilating (NVB) beta-blockers.

Methods: a meta-analysis was conducted by selecting randomized trials exploring the effect of beta-blockers on cBP. Twenty-two studies were selected. Comparisons were made between 33 trial arms (NVB=22,VB=11). In a random-effect meta-regression model, the following covariates were introduced: treatment (0=baseline, 1=treatment), drug class (VB vs NVB), interaction term: (treatment x drug class), mean age, study duration, study design, treatment-induced heart rate changes.

Results: 1225 subjects (NVB=908, VB=317) were included in the analysis. Mean pSBP was 147 mmHg for NVB and 148 mmHg for VB at baseline, and 133 mmHg for NVB and 134 mmHg for VB after treatment. The difference between pSBP and cSBP at baseline (pSBP - cSBP) was 12.9 mmHg for NVB and 13.4 mmHg for VB. Treatment with either VB or NVB determined a reduction of the above difference to 8.6 mmHg for NVB and 11.3 mmHg for VB (both p<0.01). In the final model, the effect of drug class on the difference between pSBP and cSBP (after treatment - baseline) was not significantly smaller for VB (−2.1 mmHg) than for NVB (−4.3 mmHg; p= 0.09).

Conclusions: VB have a marginally, although not significantly, less unfavourable effects on cSBP than NVB. The blood pressure-lowering effect of beta-blockers is more pronounced for pSBP than for cSBP.