The impact of beta-blockers on mortality in stable angina: a meta-analysis

Scott Med J. 2012 May;57(2):69-75. doi: 10.1258/smj.2011.011274.


Beta-blockers are recommended as first-line symptomatic treatment for stable angina. However, their impact on mortality outside the context of myocardial infarction is unknown. We performed a meta-analysis of all randomized trials of beta-blockers in stable angina. Medical databases and cardiology journals were searched for relevant randomized clinical trials. The primary outcome was cardiovascular mortality, separately considering trials of beta-blockers versus placebo and beta-blockers versus other antianginals. We conducted a subgroup analysis on cardioselective versus non-cardioselective beta-blockers and calcium channel antagonists versus nitrates. We calculated odds ratios (ORs) and confidence intervals (CIs) using Peto's method. We found no statistically significant evidence that beta-blockers impact on mortality when compared with placebo (OR, 0.42; CI , 0.15-1.21) or other antianginals (OR, 0.98; CI, 0.86-1.10), or all others (OR, 0.97; CI, 0.86-1.09). There was a trend for cardioselective beta-blockers to have a greater improvement in mortality when compared with placebo and to have greater impact than non-calcium channel antagonists. Beta-blockers do not have statistically significant impact on mortality versus placebo or versus other active comparators. The findings exclude a benefit of 15% or greater and a hazard of 10% or greater. The impact of cardioselectivity requires further study.

Publication types

  • Meta-Analysis

MeSH terms

  • Angina, Stable / drug therapy*
  • Angina, Stable / mortality
  • Antihypertensive Agents / administration & dosage
  • Antihypertensive Agents / pharmacology*
  • Calcium Channel Blockers / administration & dosage
  • Calcium Channel Blockers / pharmacology*
  • Female
  • Humans
  • Male
  • Myocardial Infarction / drug therapy
  • Myocardial Infarction / mortality
  • Myocardial Infarction / prevention & control*
  • Randomized Controlled Trials as Topic


  • Antihypertensive Agents
  • Calcium Channel Blockers