ESC Congress 2026 Abstract · Oct 26, 2026

Beta-blockers in patients with uncomplicated arterial hypertension: data from the Campania Salute Network Registry

By Basile C, Mancusi C, Fucile I et al.

Background: The role of beta-blockers in the management of uncomplicated arterial hypertension remains a subject of clinical debate. While beta-blockers are established cornerstones for heart failure and post-myocardial infarction care, their independent efficacy in reducing major adverse cardiovascular events (MACE) in patients without these compelling indications is less clear. Aim: This study aimed to evaluate the association between beta-blocker use and MACE in a real-world hypertensive population without prevalent cardiovascular diseases. Methods: We analyzed 6,702 hypertensive patients from the Campania Salute Network (CSN) registry (median age 53 years, 43% females, 9% with diabetes, 25% with obesity) without prevalent coronary or cerebrovascular disease, valvular heart disease, or heart failure. The association between beta-blocker use and MACE was assessed using three statistical approaches: multivariable-adjusted Cox proportional hazards regression, propensity score matching (PSM), and overlap weighting (OW). An intention-to-treat (ITT) analysis was performed based on baseline prescription, and a per-protocol (PP) sensitivity analysis was conducted to evaluate the role of sustained treatment adherence. Results: At baseline, 18.1% (n=1,247) of patients were receiving a beta-blocker. Over a median follow-up of 52 months, 308 MACE (4.5%) occurred. After multivariable adjustment, PSM, and OW, beta-blocker use was not associated with a lower risk of MACE in the ITT population (Adjusted hazard ratio [HR] 1.15, 95% confidence interval [CI] 0.86-1.52; PSM HR 1.18, 95% CI 0.82-1.70; OW HR 1.10, 95% CI 0.82-1.46) (Figure 1). In the per-protocol sensitivity analysis, even among adherent patients, beta-blocker therapy was not associated with a lower risk of MACE (Figure 2). Conversely, adherence to renin-angiotensin system inhibitors and statins was associated with significantly lower risk of MACE (HR for renin-angiotensin system inhibitors 0.80, 95% CI 0.66-0.98; HR for statins 0.28, 95% CI 0.11-0.70). Beta-blocker users also exhibited a higher prevalence of metabolic risk factors, including elevated triglycerides, glycemia, and uric acid levels. Conclusions: In patients with uncomplicated hypertension, beta-blocker use was not associated with a lower MACE risk, regardless of treatment adherence. These findings reinforce modern clinical guidelines that prioritize non-beta-blocker-based regimens and suggest the use of beta-blockers in the presence of specific compelling indications.Figure 1Figure 2

doi.org/10.1093/eurheartj/ehag785.3038 Open access Interventions