{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T21:09:25Z","timestamp":1789592965292,"version":"build-2803163510"},"reference-count":34,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T00:00:00Z","timestamp":1779753600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,16]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>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. This study aimed to evaluate the association between beta-blocker use and MACE in a real-world hypertensive population without prevalent cardiovascular diseases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>We analysed 6702 hypertensive patients from the Campania Salute Network (CSN) registry 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 an exploratory per-protocol (PP) sensitivity analysis was conducted to evaluate the role of sustained treatment adherence. At baseline, 18.1% (n = 1247) of patients were receiving a beta-blocker. Over a median follow-up of 52 months, 308 MACE (4.5%) occurred. After multivariable adjustment and weighting, 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\u20131.52; PSM HR 1.18, 95% CI 0.82\u20131.70; OW HR 1.10, 95% CI 0.82\u20131.46). In the exploratory PP sensitivity analysis, even among adherent patients, beta-blocker therapy was not associated with a lower risk of MACE. Conversely, adherence to renin\u2013angiotensin system inhibitors and statins was associated with a lower risk of MACE. Beta-blocker users also exhibited a higher prevalence of metabolic risk factors, including elevated triglycerides, glycaemia, and uric acid levels.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In patients with uncomplicated hypertension, beta-blocker use was not associated with a lower risk of MACE, regardless of treatment adherence. These findings are consistent with clinical guidelines that prioritize non-beta-blocker regimens and recommend using beta-blockers in the presence of compelling indications.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjqcco\/qcag089","type":"journal-article","created":{"date-parts":[[2026,5,23]],"date-time":"2026-05-23T11:39:55Z","timestamp":1779536395000},"page":"1036-1049","source":"Crossref","is-referenced-by-count":2,"title":["Beta-blockers in patients with uncomplicated arterial hypertension: data from the Campania Salute Network Registry"],"prefix":"10.1093","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4680-3058","authenticated-orcid":false,"given":"Christian","family":"Basile","sequence":"first","affiliation":[{"name":"ANMCO Research Center, Heart Care Foundation , 50121 Florence ,","place":["Italy"]},{"name":"Department of Clinical Science and Education, Karolinska Institutet , 11883 Stockholm ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6690-1408","authenticated-orcid":false,"given":"Costantino","family":"Mancusi","sequence":"additional","affiliation":[{"name":"Department of Advanced Biomedical Science, Federico II University , Via Sergio Pansini 5, 80131 Naples ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilaria","family":"Fucile","sequence":"additional","affiliation":[{"name":"Department of Advanced Biomedical Science, Federico II University , Via Sergio Pansini 5, 80131 Naples ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valentina","family":"Trimarco","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Reproductive Sciences and Dentistry, Federico II University , 80131 Naples ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eduardo","family":"Bossone","sequence":"additional","affiliation":[{"name":"Department of Public Health, Federico II University , 80131 Naples ,","place":["Italy"]},{"name":"King Faisal Specialist Hospital & Research Center Heart Centre of Excellence, , 12713 Riyadh ,","place":["Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Lembo","sequence":"additional","affiliation":[{"name":"Department of Advanced Biomedical Science, Federico II University , Via Sergio Pansini 5, 80131 Naples ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grazia","family":"Canciello","sequence":"additional","affiliation":[{"name":"Department of Advanced Biomedical Science, Federico II University , Via Sergio Pansini 5, 80131 Naples ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela","family":"Pacella","sequence":"additional","affiliation":[{"name":"Department of Public Health, Federico II University , 80131 Naples ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Giugliano","sequence":"additional","affiliation":[{"name":"Department of Advanced Biomedical Science, Federico II University , Via Sergio Pansini 5, 80131 Naples ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Angela","family":"Losi","sequence":"additional","affiliation":[{"name":"Department of Advanced Biomedical Science, Federico II University , Via Sergio Pansini 5, 80131 Naples ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3124-9912","authenticated-orcid":false,"given":"Raffaele","family":"Piccolo","sequence":"additional","affiliation":[{"name":"Department of Advanced Biomedical Science, Federico II University , Via Sergio Pansini 5, 80131 Naples ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0308-2836","authenticated-orcid":false,"given":"Raffaele","family":"Izzo","sequence":"additional","affiliation":[{"name":"Department of Advanced Biomedical Science, Federico II University , Via Sergio Pansini 5, 80131 Naples ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-5118-3976","authenticated-orcid":false,"given":"Carmine","family":"Morisco","sequence":"additional","affiliation":[{"name":"Department of Advanced Biomedical Science, Federico II University , Via Sergio Pansini 5, 80131 Naples ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Esposito","sequence":"additional","affiliation":[{"name":"Department of Advanced Biomedical Science, Federico II University , Via Sergio Pansini 5, 80131 Naples ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,5,26]]},"reference":[{"key":"2026091606044239800_qcag089-B1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD002003.pub5","article-title":"Beta-blockers for hypertension","volume":"1","author":"Wiysonge","year":"2017","journal-title":"Cochrane Database Syst Rev"},{"key":"2026091606044239800_qcag089-B2","doi-asserted-by":"publisher","first-page":"1153","DOI":"10.1161\/hypertensionaha.122.19020","article-title":"Individualized Beta-blocker treatment for high blood pressure dictated by medical comorbidities: indications beyond the 2018 European Society of Cardiology\/European Society of Hypertension Guidelines","volume":"79","author":"Mancia","year":"2022","journal-title":"Hypertension"},{"key":"2026091606044239800_qcag089-B3","doi-asserted-by":"publisher","first-page":"1874","DOI":"10.1097\/hjh.0000000000003480","article-title":"2023 ESH Guidelines for the management of arterial hypertension. The Task Force for the management of arterial hypertension of the European Society of Hypertension: Endorsed by the International Society of Hypertension (ISH) and the European Renal Association (ERA)","volume":"41","author":"Mancia","year":"2023","journal-title":"J Hypertens"},{"key":"2026091606044239800_qcag089-B4","doi-asserted-by":"publisher","first-page":"1819","DOI":"10.1016\/j.amjcard.2010.08.023","article-title":"Beta-blockers in hypertension","volume":"106","author":"Ram","year":"2010","journal-title":"Am J Cardiol"},{"key":"2026091606044239800_qcag089-B5","doi-asserted-by":"publisher","first-page":"1804","DOI":"10.1161\/circresaha.114.302524","article-title":"The autonomic nervous system and hypertension","volume":"114","author":"Mancia","year":"2014","journal-title":"Circ Res"},{"key":"2026091606044239800_qcag089-B6","doi-asserted-by":"publisher","DOI":"10.3390\/cimb47070501","article-title":"Angiotensin II and cardiovascular disease: balancing pathogenic and protective pathways","volume":"47","author":"Bayraktutan","year":"2025","journal-title":"Curr Issues Mol Biol"},{"key":"2026091606044239800_qcag089-B7","doi-asserted-by":"publisher","first-page":"1545","DOI":"10.1016\/s0140-6736(05)67573-3","article-title":"Should beta blockers remain first choice in the treatment of primary hypertension? A meta-analysis","volume":"366","author":"Lindholm","year":"2005","journal-title":"Lancet"},{"key":"2026091606044239800_qcag089-B8","volume-title":"Hypertension: Management in Adults in Primary Care: Pharmacological Update","author":"National Collaborating Centre for Chronic Conditions","year":"2006"},{"key":"2026091606044239800_qcag089-B9","doi-asserted-by":"publisher","first-page":"3912","DOI":"10.1093\/eurheartj\/ehae178","article-title":"2024 ESC Guidelines for the management of elevated blood pressure and hypertension","volume":"45","author":"McEvoy","year":"2024","journal-title":"Eur Heart J"},{"key":"2026091606044239800_qcag089-B10","doi-asserted-by":"publisher","DOI":"10.1161\/hyp.0000000000000257","article-title":"Correction to: 2025 AHA\/ACC\/AANP\/AAPA\/ABC\/ACCP\/ACPM\/AGS\/AMA\/ASPC\/NMA\/PCNA\/SGIM Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines","volume":"82","author":"Jones","year":"2025","journal-title":"Hypertension"},{"key":"2026091606044239800_qcag089-B11","doi-asserted-by":"publisher","first-page":"1774","DOI":"10.1093\/eurjpc\/zwad224","article-title":"Normalization of ascending aorta dimension for body size influences pathophysiologic correlation in hypertensive patients: the Campania Salute Network","volume":"30","author":"Mancusi","year":"2023","journal-title":"Eur J Prev Cardiol"},{"key":"2026091606044239800_qcag089-B12","doi-asserted-by":"publisher","first-page":"1852","DOI":"10.1097\/hjh.0000000000002847","article-title":"Impact of visit-to-visit blood pressure variability on hypertensive-mediated target organ damage and future cardiovascular events: the Campania salute network","volume":"39","author":"Mancusi","year":"2021","journal-title":"J Hypertens"},{"key":"2026091606044239800_qcag089-B13","doi-asserted-by":"publisher","first-page":"577","DOI":"10.1093\/ehjci\/jev076","article-title":"Recommendations on the use of echocardiography in adult hypertension: a report from the European Association of Cardiovascular Imaging (EACVI) and the American Society of Echocardiography (ASE)","volume":"16","author":"Marwick","year":"2015","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"2026091606044239800_qcag089-B14","doi-asserted-by":"publisher","first-page":"745","DOI":"10.1097\/hjh.0000000000000477","article-title":"Cardiovascular risk in relation to a new classification of hypertensive left ventricular geometric abnormalities","volume":"33","author":"de Simone","year":"2015","journal-title":"J Hypertens"},{"key":"2026091606044239800_qcag089-B15","doi-asserted-by":"publisher","first-page":"657","DOI":"10.1007\/s40292-025-00745-6","article-title":"Abdominal aorta remodeling in hypertensive patients: the Campania Salute Network","volume":"32","author":"Mancusi","year":"2025","journal-title":"High Blood Press Cardiovasc Prev"},{"key":"2026091606044239800_qcag089-B16","doi-asserted-by":"publisher","first-page":"262","DOI":"10.1016\/j.echo.2016.11.017","article-title":"Validation of left atrial volume estimation by left atrial diameter from the parasternal long-axis view","volume":"30","author":"Canciello","year":"2017","journal-title":"J Am Soc Echocardiogr"},{"key":"2026091606044239800_qcag089-B17","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1016\/j.echo.2014.11.015","article-title":"Multimodality imaging of diseases of the thoracic aorta in adults: from the American Society of Echocardiography and the European Association of Cardiovascular Imaging: endorsed by the Society of Cardiovascular Computed Tomography and Society for Cardiovascular Magnetic Resonance","volume":"28","author":"Goldstein","year":"2015","journal-title":"J Am Soc Echocardiogr"},{"key":"2026091606044239800_qcag089-B18","doi-asserted-by":"publisher","first-page":"813","DOI":"10.1097\/HJH.0b013e32835e8f5b","article-title":"A prospective, randomized, open-label, active-controlled, clinical trial to assess central haemodynamic effects of bisoprolol and atenolol in hypertensive patients","volume":"31","author":"Park","year":"2013","journal-title":"J Hypertens"},{"key":"2026091606044239800_qcag089-B19","doi-asserted-by":"publisher","first-page":"1213","DOI":"10.1161\/circulationaha.105.595496","article-title":"Differential impact of blood pressure-lowering drugs on central aortic pressure and clinical outcomes: principal results of the Conduit Artery Function Evaluation (CAFE) study","volume":"113","author":"Williams","year":"2006","journal-title":"Circulation"},{"key":"2026091606044239800_qcag089-B20","doi-asserted-by":"publisher","first-page":"248","DOI":"10.1161\/hypertensionaha.111.187070","article-title":"The Anglo-Scandinavian cardiac outcomes trial: implications and further outcomes","volume":"60","author":"Sever","year":"2012","journal-title":"Hypertension"},{"key":"2026091606044239800_qcag089-B21","doi-asserted-by":"publisher","first-page":"449","DOI":"10.1016\/j.amjmed.2024.10.016","article-title":"Comparative analysis of first-line antihypertensive treatment classes","volume":"138","author":"Abuhasira","year":"2025","journal-title":"Am J Med"},{"key":"2026091606044239800_qcag089-B22","doi-asserted-by":"publisher","first-page":"627","DOI":"10.1111\/jch.13531","article-title":"First-line treatment of essential hypertension: a real-world analysis across four antihypertensive treatment classes","volume":"21","author":"Stapff","year":"2019","journal-title":"J Clin Hypertens"},{"key":"2026091606044239800_qcag089-B23","doi-asserted-by":"publisher","DOI":"10.1155\/2022\/6124559","article-title":"Real-world effectiveness of beta-blockers versus other antihypertensives in reducing all-cause mortality and cardiovascular events","volume":"2022","author":"Foch","year":"2022","journal-title":"Int J Clin Pract"},{"key":"2026091606044239800_qcag089-B24","doi-asserted-by":"publisher","first-page":"351","DOI":"10.1111\/j.1524-6175.2005.04679.x","article-title":"Do the metabolic effects of beta blockers make them leading or supporting antihypertensive agents in the treatment of hypertension?","volume":"8","author":"Sarafidis","year":"2006","journal-title":"J Clin Hypertens"},{"key":"2026091606044239800_qcag089-B25","doi-asserted-by":"publisher","first-page":"615","DOI":"10.1185\/03007990903533681","article-title":"Effects of beta-blockers on glucose and lipid metabolism","volume":"26","author":"Fonseca","year":"2010","journal-title":"Curr Med Res Opin"},{"key":"2026091606044239800_qcag089-B26","doi-asserted-by":"publisher","first-page":"250","DOI":"10.1161\/01.hyp.37.2.250","article-title":"Hypothesis: beta-adrenergic receptor blockers and weight gain: a systematic analysis","volume":"37","author":"Sharma","year":"2001","journal-title":"Hypertension"},{"key":"2026091606044239800_qcag089-B27","doi-asserted-by":"publisher","first-page":"698","DOI":"10.1161\/hypertensionaha.117.09685","article-title":"Chicken or the egg? Hyperuricemia, insulin resistance, and hypertension","volume":"70","author":"Dawson","year":"2017","journal-title":"Hypertension"},{"key":"2026091606044239800_qcag089-B28","doi-asserted-by":"publisher","first-page":"540","DOI":"10.1056\/NEJMoa2512686","article-title":"Beta-blockers after myocardial infarction with normal ejection fraction","volume":"394","author":"Kristensen","year":"2026","journal-title":"N Engl J Med"},{"key":"2026091606044239800_qcag089-B29","doi-asserted-by":"publisher","first-page":"931","DOI":"10.1161\/circulationaha.124.072855","article-title":"Withdrawal of guideline-directed medical therapy in patients with heart failure and improved ejection fraction","volume":"151","author":"Basile","year":"2025","journal-title":"Circulation"},{"key":"2026091606044239800_qcag089-B30","doi-asserted-by":"publisher","first-page":"1611","DOI":"10.1161\/circulationaha.110.983874","article-title":"Meta-analysis: impact of drug class on adherence to antihypertensives","volume":"123","author":"Kronish","year":"2011","journal-title":"Circulation"},{"key":"2026091606044239800_qcag089-B31","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1161\/hypertensionaha.118.12495","article-title":"Antihypertensive medication nonpersistence and low adherence for adults &lt;65 years initiating treatment in 2007\u20132014","volume":"74","author":"Tajeu","year":"2019","journal-title":"Hypertension"},{"key":"2026091606044239800_qcag089-B32","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1007\/s40292-024-00687-5","article-title":"Effect of nebivolol monotherapy or combination therapy on blood pressure levels in patients with hypertension: an updated systematic review and multilevel meta-analysis of 91 randomized controlled trials","volume":"32","author":"Manolis","year":"2025","journal-title":"High Blood Press Cardiovasc Prev"},{"key":"2026091606044239800_qcag089-B33","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1007\/s40292-025-00761-6","article-title":"Rationale for the use of fixed combination therapies with angiotensin converting enzyme inhibitors and beta-blockers in patients with essential hypertension and high cardiovascular risk: a consensus document from the Italian Society of Arterial Hypertension (SIIA) and the Italian Society of Cardiovascular Prevention (SIPREC)","volume":"33","author":"Virdis","year":"2026","journal-title":"High Blood Press Cardiovasc Prev"},{"key":"2026091606044239800_qcag089-B34","doi-asserted-by":"publisher","first-page":"821","DOI":"10.1016\/j.jacc.2005.05.051","article-title":"Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers for prevention of type 2 diabetes: a meta-analysis of randomized clinical trials","volume":"46","author":"Abuissa","year":"2005","journal-title":"J Am Coll Cardiol"}],"container-title":["European Heart Journal - Quality of Care and Clinical Outcomes"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ehjqcco\/advance-article-pdf\/doi\/10.1093\/ehjqcco\/qcag089\/68386122\/qcag089.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjqcco\/article-pdf\/12\/6\/1036\/68386122\/qcag089.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjqcco\/article-pdf\/12\/6\/1036\/68386122\/qcag089.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T10:04:49Z","timestamp":1789553089000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ehjqcco\/article\/12\/6\/1036\/8692875"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,26]]},"references-count":34,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,5,26]]},"published-print":{"date-parts":[[2026,9,16]]}},"URL":"https:\/\/doi.org\/10.1093\/ehjqcco\/qcag089","relation":{},"ISSN":["2058-5225","2058-1742"],"issn-type":[{"value":"2058-5225","type":"print"},{"value":"2058-1742","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,9]]},"published":{"date-parts":[[2026,5,26]]}}}