Results of a study in this week's issue of THE LANCET suggest that atenolol--one of the most widely prescribed beta-blockers for reducing blood pressure--may not be effective in reducing heart attacks or death from cardiovascular causes.
Atenolol is one of the most commonly used beta-blockers clinically, and has often been used as a reference drug in randomised controlled trials of high blood pressure. Concerns that atenolol may not be the best reference drug for comparison with other antihypertensive drugs led Bo Carlberg (Umea University Hospital, Sweden) and colleagues to systematically review the effect of atenolol on cardiovascular illness and death among patients with high blood pressure.
The investigators identified four studies that compared atenolol with placebo or no treatment, and five studies that compared atenolol with other antihypertensive drugs.
Atenolol was no different to placebo in terms of death from all causes, cardiovascular causes, or incidence of heart attack; a trend in reduced stroke incidence was the only favourable outcome. Atenolol slightly increased all-cause mortality compared with other antihypertensive drugs, in addition to showing a trend to increased cardiovascular death and increased stroke incidence.
Co-author Lars H Lindholm comments: "We have some doubts about the suitability of atenolol as a first-line antihypertensive drug and as a reference drug in outcome trials of hypertension."
Contact: Professor Lars Hjalmar Lindholm, Department of Public Health and Clinical Medicine, Umea University, SE 901 85 Umea, Sweden; T) 46-90-785-3526; mobile 46-70-585-3526; LarsH.Lindholm@fammed.umu.se
Dr. Bo Carlberg, Umea University Hospital T) 46-90-785-1443; mobile 46-70-577-5883; Bo.Carlberg@medicin.umu.se