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First-Line β-Blocker Use for Hypertension in the Veterans Health Administration
Catherine G Derington1, Ransmond O Berchie1, April F Mohanty2,3
1Intermountain Healthcare Department of Population Health Sciences, Divisions of Health System Innovation and Research and Biostatistics, Spencer Fox-Eccles School of Medicine, University of Utah, Salt Lake City.
JAMA Network Open
|August 27, 2025
Summary
Most veterans initiated beta-blockers for hypertension without clear medical need, contrary to guidelines. Older, female, White, and frail veterans were more likely to receive these guideline-discordant treatments.
Area of Science:
- Cardiology
- Pharmacology
- Public Health
Background:
- US guidelines since 2014 advise against beta-blockers as first-line hypertension treatment without specific conditions.
- Concerns exist regarding their tolerability and effectiveness compared to alternatives for stroke and mortality reduction.
- The actual practice patterns and influencing factors for this guideline-discordant use remain unclear.
Purpose of the Study:
- To determine the prevalence of first-line beta-blocker use in hypertension patients lacking compelling indications.
- To identify demographic and clinical factors associated with this non-guideline-concordant prescribing practice.
Main Methods:
- A serial cross-sectional study analyzed national patient-level data from the Veterans Health Administration (2000-2022).
- Included were new users of antihypertensive medications for newly diagnosed hypertension.
- Multivariable Poisson regression assessed factors linked to beta-blocker initiation in patients without compelling indications.
Main Results:
- Out of 3,138,304 veterans, 24.7% initiated beta-blockers; 88.2% lacked compelling indications.
- Guideline-discordant use decreased from 91.8% (2000-2005) to 81.5% (2018-2022).
- Older, female, non-Hispanic White, and frail veterans showed higher odds of beta-blocker initiation.
Conclusions:
- A significant proportion of veterans initiate beta-blockers for hypertension without compelling indications.
- Factors such as age, sex, race, and frailty are associated with this practice.
- Interventions are necessary to promote guideline-adherent hypertension management.
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