Beta-blockers (All routes except ocular) (versus unexposed) updated on 12-17-2024

Preeclampsia

R analysis
id Study   Lib. in paper Exposition period    Study type 
 Control type 
 
Tags OR 95%CI x1/n1 x0/n0 no cases no exposed ROB Ref.
S17151
R71923		 Al Khalaf - Beta-blockers (Controls unexposed, disease free), 2022 Preeclampsia (based on read or ICD-10 codes) during pregnancy (anytime or not specified) retrospective cohort (claims database) unexposed, disease free excluded Adjustment: No Indications Antihypertensive: Only chronic hypertension indication 7.27 [6.32;8.37] C
excluded (control group) 		220/1,952   29,859/1,739,944 30,079 1,952
ref
S17148
R71900		 Al Khalaf - Beta-blockers (Controls unexposed, sick), 2022 Preeclampsia (based on read or ICD-10 codes) during pregnancy (anytime or not specified) retrospective cohort (claims database) unexposed, sick Adjustment: No Indications Antihypertensive: Only chronic hypertension indication 1.06 [0.90;1.24] C 220/1,952   839/7,809 1,059 1,952
ref
S14051
R55678		 Xiang - Labetalol, 2020 Preeclampsia during pregnancy (anytime or not specified) randomized controlled trial unexposed, sick Adjustment: Randomisation Indications Antihypertensive: Only chronic hypertension indication 0.45 [0.27;0.76] C 38/127   61/126 99 127
ref
S13902
R54404		 Duan - Beta-blockers, 2018 Preeclampsia during pregnancy (anytime or not specified) retrospective cohort (claims database) unexposed (general population or NOS) Adjustment: No Indications Antihypertensive: All hypertensions, any indications or not specified 3.16 [2.56;3.89] C 94/4,847   2,330/374,391 2,424 4,847
ref
S13809
R54310		 Hoeltzenbein c - Bisoprolol, 2018 Preeclampsia at least 1st trimester prospective cohort unexposed, disease free Adjustment: Yes Indications Antihypertensive: All hypertensions, any indications or not specified 2.44 [1.01;5.89] 14/172   10/351 24 172
ref
S13480
R52006		 Orbach - Atenolol, 2013 Preeclampsia 3rd trimester retrospective cohort (claims database) unexposed, disease free Adjustment: Yes Indications Antihypertensive: All hypertensions, any indications or not specified 9.38 [4.84;18.16] 10/107   1,093/97,820 1,103 107
ref
S13385
R54065		 Bayliss - Atenolol, 2002 Superimposed Pre-eclampsia (before and after 30 weeks) throughout pregnancy retrospective cohort unexposed, sick Adjustment: No Indications Antihypertensive: Only chronic hypertension indication 0.52 [0.23;1.17] C 9/40   61/171 70 40
ref
S13587
R52686		 Lydakis - Atenolol, 1999 Preeclampsia during pregnancy (anytime or not specified) retrospective cohort unexposed, sick Adjustment: No Indications Antihypertensive: Only chronic hypertension indication 1.10 [0.48;2.51] C 13/78   14/91 27 78
ref
Total 7 studies 1.54 [0.79;3.00] 4,806 7,323
x1: number of endpoints among exposed, n1: number of exposed; x0: number of endpoints among non exposed, n0: number of non exposed; C: calculated odds ratio from numbers of events and effectives

Forest plot

StudyTE95% CIn casesn exposedweightROBABCDEF Al Khalaf - Beta-blockers (Controls unexposed, sick), 2022Al Khalaf - Beta-blockers, 2022 1 1.06[0.90; 1.24]1,0591,95216%ROB confusion: criticalROB selection: unclearROB classification: criticalROB missing: lowROB mesure: moderateROB reporting: moderate Xiang - Labetalol, 2020Xiang - Labetalol, 2020 0.45[0.27; 0.76]9912715%ROB confusion: lowROB selection: lowROB classification: moderateROB missing: lowROB mesure: moderateROB reporting: moderate Duan - Beta-blockers, 2018Duan - Beta-blockers, 2018 3.16[2.56; 3.89]2,4244,84716%ROB confusion: criticalROB selection: lowROB classification: moderateROB missing: unclearROB mesure: moderateROB reporting: moderate Hoeltzenbein c - Bisoprolol, 2018Hoeltzenbein c - Bisoprolol, 2018 2.44[1.01; 5.89]2417213%ROB confusion: seriousROB selection: moderateROB classification: moderateROB missing: lowROB mesure: criticalROB reporting: moderate Orbach - Atenolol, 2013Orbach - Atenolol, 2013 9.38[4.84; 18.16]1,10310714%ROB confusion: criticalROB selection: lowROB classification: moderateROB missing: lowROB mesure: moderateROB reporting: moderate Bayliss - Atenolol, 2002Bayliss - Atenolol, 2002 0.52[0.23; 1.17]704013%ROB confusion: criticalROB selection: lowROB classification: criticalROB missing: unclearROB mesure: moderateROB reporting: moderate Lydakis - Atenolol, 1999Lydakis - Atenolol, 1999 1.10[0.48; 2.51]277813%ROB confusion: seriousROB selection: moderateROB classification: criticalROB missing: unclearROB mesure: moderateROB reporting: moderate Total (7 studies) I2 = 95% 1.54[0.79; 3.00]4,8067,3230.220.01.0ROB: A: confusion, B: selection, C: classification, D: missing, E: measurement, F: reportinglow,moderate,serious,critical,unclear,

1: Controls unexposed, sick;

Sensitivity analysis

SubsetTE95% CIn casesn exposedkI2 Type of studies cohort studiescohort studies 1.90[0.94; 3.84]4,7077,19695%NAAl Khalaf - Beta-blockers (Controls unexposed, sick), 2022 Duan - Beta-blockers, 2018 Hoeltzenbein c - Bisoprolol, 2018 Orbach - Atenolol, 2013 Bayliss - Atenolol, 2002 Lydakis - Atenolol, 1999 6 case control studiescase control studies 0 RCTRCT 0.45[0.27; 0.76]99127 -NAXiang - Labetalol, 2020 1 Type of controls unexposed (disease free or unspecified)unexposed (disease free or unspecified) 4.17[2.00; 8.71]3,5515,12680%NADuan - Beta-blockers, 2018 Hoeltzenbein c - Bisoprolol, 2018 Orbach - Atenolol, 2013 3 unexposed, sickunexposed, sick 0.74[0.45; 1.24]1,2552,19774%NAAl Khalaf - Beta-blockers (Controls unexposed, sick), 2022 Xiang - Labetalol, 2020 Bayliss - Atenolol, 2002 Lydakis - Atenolol, 1999 4 Tags Adjustment   - No  - No 1.24[0.57; 2.71]3,5806,91796%NAAl Khalaf - Beta-blockers (Controls unexposed, sick), 2022 Duan - Beta-blockers, 2018 Bayliss - Atenolol, 2002 Lydakis - Atenolol, 1999 4   - Randomisation  - Randomisation 0.45[0.27; 0.76]99127 -NAXiang - Labetalol, 2020 1   - Yes  - Yes 4.94[1.32; 18.47]1,12727983%NAHoeltzenbein c - Bisoprolol, 2018 Orbach - Atenolol, 2013 2 Indications Antihypertensive   - All hypertensions, any indications ...  - All hypertensions, any indications or not specified 4.17[2.00; 8.71]3,5515,12680%NADuan - Beta-blockers, 2018 Hoeltzenbein c - Bisoprolol, 2018 Orbach - Atenolol, 2013 3   - Only chronic hypertension indication  - Only chronic hypertension indication 0.74[0.45; 1.24]1,2552,19774%NAAl Khalaf - Beta-blockers (Controls unexposed, sick), 2022 Xiang - Labetalol, 2020 Bayliss - Atenolol, 2002 Lydakis - Atenolol, 1999 4 All studiesAll studies 1.54[0.79; 3.00]4,8067,32395%NAAl Khalaf - Beta-blockers (Controls unexposed, sick), 2022 Xiang - Labetalol, 2020 Duan - Beta-blockers, 2018 Hoeltzenbein c - Bisoprolol, 2018 Orbach - Atenolol, 2013 Bayliss - Atenolol, 2002 Lydakis - Atenolol, 1999 70.220.01.0

Publication bias and p-hacking diagnosis

funnel plot
0.0-2.72.70.5400.000Al Khalaf - Beta-blockers (Controls unexposed, sick), 2022Xiang - Labetalol, 2020Duan - Beta-blockers, 2018Hoeltzenbein c - Bisoprolol, 2018Orbach - Atenolol, 2013Bayliss - Atenolol, 2002Lydakis - Atenolol, 1999

Asymetry test p-value = 0.9327 (by Egger's regression)

slope=0.3871 (0.4987); intercept=0.2817 (3.1722); t=0.0888; p=0.9327

p values plot
0.01.00.01.0

Sub-groups analysis using all included studies

excluded 17151

Sub-groupsTE95% CIn casesn exposedkI2ROB type of controls unexposed controls (disease free or unspecified)unexposed controls (disease free or unspecified) 4.93[2.68; 9.04]33,6307,07894%NAAl Khalaf - Beta-blockers (Controls unexposed, disease free), 2022 Duan - Beta-blockers, 2018 Hoeltzenbein c - Bisoprolol, 2018 Orbach - Atenolol, 2013 4 unexposed, sick controlsunexposed, sick controls 0.74[0.45; 1.24]1,2552,19774%NAAl Khalaf - Beta-blockers (Controls unexposed, sick), 2022 Xiang - Labetalol, 2020 Bayliss - Atenolol, 2002 Lydakis - Atenolol, 1999 40.510.01.0

Umbrella review (other published meta-analyses)

Published MAControlPeriodTE95% CIn exposedkI2 Bellos - Atenolol (Preeclampsia (Randomized c ...Bellos - Atenolol (Preeclampsia (Randomized controlled trial and Cohort studies)) 0.52[0.25; 1.07]NA-U,Sunexposed, sickAnyduring pregnancy (anytime or not specified)studies TTT-9 Bellos - Labetalol (Preeclampsia (Randomized ...Bellos - Labetalol (Preeclampsia (Randomized controlled trial and Cohort studies)) 0.79[0.38; 1.61]NA-U,Sunexposed, sickAnyduring pregnancy (anytime or not specified)studies TTT-9 Bellos - Pindolol (Preeclampsia (Randomized c ...Bellos - Pindolol (Preeclampsia (Randomized controlled trial and Cohort studies)) 0.52[0.07; 3.88]NA-U,Sunexposed, sickAnyduring pregnancy (anytime or not specified)studies TTT-9 Bellos - Atenolol (Preeclampsia (Randomized c ...Bellos - Atenolol (Preeclampsia (Randomized controlled trial only)) Out of scale0.15[0.02; 1.27]NA-U,Sunexposed, sickAnyduring pregnancy (anytime or not specified)studies TTT-9 Bellos - Labetalol (Preeclampsia (Randomized ...Bellos - Labetalol (Preeclampsia (Randomized controlled trial only)) 0.51[0.15; 1.76]NA-U,Sunexposed, sickAnyduring pregnancy (anytime or not specified)studies TTT-9 Bellos - Pindolol (Preeclampsia (Randomized c ...Bellos - Pindolol (Preeclampsia (Randomized controlled trial only)) Out of scale0.38[0.04; 3.87]NA-U,Sunexposed, sickAnyduring pregnancy (anytime or not specified)studies TTT-9 Abalos (Proteinuria/pre-eclampsia (RCT versus ...Abalos (Proteinuria/pre-eclampsia (RCT versus no antihypertensive drugs/placebo)) 0.74[0.56; 0.99]9.5%-U,Sunexposed, sickAnyduring pregnancy (anytime or not specified)studies TTT8 Bone - GESTATIONAL HYPERTENSION (Severe hyper ...Bone - GESTATIONAL HYPERTENSION (Severe hypertension) Out of scale0.47[0.24; 0.89]24%-U,Sunexposed, sickAnyduring pregnancy (anytime or not specified)studies TTT-9 Bone - GESTATIONAL HYPERTENSION (Severe hyper ...Bone - GESTATIONAL HYPERTENSION (Severe hypertension (versus methyldopa)) 0.76[0.44; 1.26]42%-Eexposed to other treatment, sickAnyduring pregnancy (anytime or not specified)studies TTT-9 metaPregmetaPreg 1.54[0.79; 3.00]95%7,323----Al Khalaf - Beta-blockers (Controls unexposed, sick), 2022 Xiang - Labetalol, 2020 Duan - Beta-blockers, 2018 Hoeltzenbein c - Bisoprolol, 2018 Orbach - Atenolol, 2013 Bayliss - Atenolol, 2002 Lydakis - Atenolol, 1999 70.510.01.0