Can i discontinue tenormin 25 when it is prescribed for. Atenolol is widely used as a firstline therapy for hypertension. The choice of more expensive agents, where cheaper ones would be equally effective, may have negative impacts on national healthcare budgets. Mean reduction in blood pressure bp attributed to atenolol ranged from 4. It is possible that the controversy with betablockers arises because atenolol. Elevated blood pressure, or hypertension, is associated with serious health problems, such as strokes, heart attacks, and kidney failure. Should betablockers remain first choice in the treatment of primary hypertension. However, it has been shown that bbs reduce blood pressure less than other drugs, specifically with regard to central aortic pressure. Atenolol is widely used as a firstline therapy for hypertension because it is beta 1 selective and it has low lipophilicity, which should result in fewer central nervous system side effects. They also concluded that atenolol is not an appropriate choice for uncomplicated hypertension in older hypertensive patients with significantly worse outcomes. Longterm treatment with traditional nonvasodilating. Bibliographic details carlberg b, samuelsson o, lindholm l h. Atenolol has fared the worse in comparison to some beta blockers, the researchers and doctors from st.
Current strategies in hypertension current strategies in. Joe graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. National and international guidelines still recommend. Atenolol is unsuitable as a firstline drug in hypertension. They pointed out the significantly lesser benefit of betablocker therapy in 2 trials versus. Mar 22, 2020 more doubts cast on betablockers as first choice in uncomplicated hypertension results of a new metaanalysis suggest that the era of beta blockers for hypertension is over and further analysis of the newly unblinded hypertension assignments in ascot pair the 2002 lipidlowering arm results supporting atorvastatin with the 2005 blood pressurelowering arm results endorsing amlodipine. Recent evidence suggests that central blood pressure is a more important determinant of cardiovascular risk than brachial pressure. Jnc 7 recommendations to use betablockers as firstline therapy in patients with. It differs from pindolol and proponolol in that it does not have an intrinsic sympathomimetic action or membrane stabilising activity. Twelve patients whose mood pressure was not wellcontrolled on methyldopa and chlorthalidone and 11 patients who were treated previously with other betablockers all benefited from atenolol which appeared to be effective and welltolerated. There are many classes of antihypertensives, whichby. Stroke was also more frequent with atenolol treatment. Hypertension htn is a largely asymptomatic disease affecting around 50 million americans and one billion people worldwide.
Baron md professor of medicine associate dean for gme and cme declaration of full disclosure. Effects of different regimens to lower blood pressure on major cardiovascular events in older and younger adults. Blockers in hypertension, diabetes, heart failure and. When not to use betablockers in seniors with hypertension. A new metaanalysis has raised doubts about the suitability of atenolol as a firstline antihypertensive drug and as a reference drug in outcome trials of hypertension. Pdf beta blockers in hypertension and cardiovascular disease. In patients with essential hypertension, atenolol is not better than placebo or no treatment for reducing cardiovascular morbidity or all cause mortality. Our results cast doubts on atenolol as a suitable drug for hypertensive patients. In patients with hypertension and left ventricular hypertrophy in the life study, there were significantly higher risks, adjusted for the framingham risk score, for the primary composite end point, stroke, and total mortality in the highest versus lowest quartile of pulse pressure with atenolol based treatment. The role of betablockers as firstline therapy in hypertension.
However, questions have been raised about atenolol as the best reference drug for comparisons with other antihypertensives. For all indications the choice is among bisoprolol. Blockers are among the most commonly used medications in the treatment of hypertension. It required 2 papers in the lancet from 3 swedish authors, with their accompanying editorials, to bring the issue to the currently almost unanimous agreement that betablockers are no longer an appropriate choice for initial or, as stated in the 2006 bhs addendum, subsequent therapy of uncomplicated hypertension. The problem was first recognized by messerli et al. In patients with hypertension and left ventricular hypertrophy in the life study, there were significantly higher risks, adjusted for the framingham risk score, for the primary composite end point, stroke, and total mortality in the highest versus lowest quartile of pulse pressure with atenolol. Use of betablockers for uncomplicated hypertension in the. Hydralazine and its derivatives are also used in the treatment of severe hypertension, although they should be avoided in emergencies.
Current strategies in hypertension current strategies. Atenolol in hypertension journal of association of. Antihypertensive drug wikipedia republished wiki 2. His bestselling book, the peoples pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. Moreover, they challenge the use of atenolol as a reference drug in outcome trials in hypertension. Background atenolol is one of the most widely used beta blockers clinically, and has often been used as a reference drug in randomised controlled trials of hypertension. Randomised controlled trials that assessed the effect of atenolol on cardiovascular morbidity or mortality in patients with primary hypertension were included. Hypertension is an important risk factor for cardiovascular disease, affecting. This has been confirmed by a 2007 cochrane analysis. Indeed, the carlberg metaanalysis demonstrated the inferiority of atenolol in preventing cardiovascular events when compared to other active antihypertensive treatments. However, 45 years after their initial indication for that treatment, their place in the treatment of. Pulse pressure and effects of losartan or atenolol in.
Evidence suggests that atenolol is less effective than certain other betablockers and drugs from other pharmacologic classes in reducing cardiovascular risk when used to treat hypertension. Although treatment with atenolol may no longer be a wise choice in patients with hypertension and high pp, 8,25 losartanbased treatment appears to offer powerful cardiovascular protection to these. Au carlberg b, samuelsson o, lindholm lh so lancet. Evidence suggests that atenolol is less effective than certain other betablockers and drugs from other pharmacologic classes in reducing cardiovascular risk when used to treat hypertension, particularly in older adults. As of 2018, the best available evidence favors lowdose thiazide diuretics as the firstline treatment of choice for high blood pressure when drugs are necessary. Atenolol is one of the most widely used beta blockers clinically, and has often been used as a reference drug in randomised. Disturbingly, these bb choices in the patients with hf are not evidencebased. However, a recent metaanalysis of the early bp trials involving atenolol, either placebocontrolled or using drug comparisons, has cast doubt on the suitability of atenolol as an antihypertensive agent. More importantly, recent metaanalyses have highlighted that in primary prevention bbs are associated with a relatively weak.
The rates of stroke and cardiovascular and allcause mortality were greater in the atenolol group than in the other antihypertensive drug group table. Openurl1crossref2pubmed3web of science4 q in patients with essential hypertension, does atenolol reduce cardiovascular morbidity or all cause mortality. The lessthanadequate effect of betablockers in lowering the blood pressure and on vascular protection, and the unfavorable effects of these drugs, as. Antihypertensives are a class of drugs that are used in medicine and pharmacology to treat hypertension high blood pressure. Accumulated evidence suggests that atenolol is not sufficiently effective as a primary tool to treat hypertension.
Comments to the 2007 recommendations for the treatment of. All elderly patients in ontario, canada population over 3. Lukes medical and other major medical centers said that the vasodilating beta blockers should be the only ones used if a beta blocker is the choice. Blood pressure lowering treatment trialists collaboration, turnbull f, neal b, et al. Atenolol, metoprolol, bisoprolol and nebivolol are. Rethinking atenolol as a firstline antihypertensive. At this point, it is rather unclear whether or not betablockers are indicated as a first choice in patients with essential arterial hypertension. Several randomized controlled trials clearly demonstrate that modest reductions in blood pressure bp can significantly reduce the excess morbidity and mortality associated with hypertension. An application to recommend that the representative of the beta. Blockers in hypertension, diabetes, heart failure and acute. Prompted by a finding that the angiotensinreceptor. Clinical impact ratings gpfpprimary care q imambulatory care w cardiology wwqq.
More doubts cast on betablockers as first choice in uncomplicated hypertension results of a new metaanalysis suggest that the era of beta blockers for hypertension is over and further analysis of the newly unblinded hypertension. Betablockers have been found not to be effective for primary prevention of cardiovascular disease in patients with primary hypertension. Achieved reductions in sbp, dbp, and pp could not explain the differences in cardiovascular outcomes between treatment groups in the life study. Reducing heart rate with beta blockers in hypertension is. Atenolol is one of the most widely used beta blockers clinically, and has often been used as a reference drug in randomised controlled trials of hypertension.
However, questions have been raised about atenolol as the best reference drug for. Are there big differences among betablockers in treating. Atenolol is used for a number of conditions including hypertension, angina, long qt syndrome, acute myocardial infarction, supraventricular tachycardia, ventricular tachycardia, and the symptoms of alcohol withdrawal. The authors concluded that atenolol may not be a suitable treatment option for patients with hypertension. Medical research council trial of treatment of hypertension. Effects of different regimens to lower blood pressure on major cardiovascular events in. The authors concluded that atenolol may not be a suitable treatment option for patients with hypertension, and queried its use as a reference drug in trials. They are no longer indicated as firstline therapy for high blood pressure due to side effects and safety concerns, but hydralazine remains a drug of choice in gestational hypertension. Betablockers in the management of hypertension andor.
Atenolol is mostly used to treat hypertension and as preventive medicine for chest pain for which continuous longterm consumption is the norm carlberg et al. Diastolic dysfunction atenolol 25100 mg daily lisinopril 540 mg daily lisinoprilhctz 1012. Mar 19, 2020 medications to treat hypertension should both lower blood pressure and protect the heart. Indeed, the carlberg metaanalysis demonstrated the inferiority of atenolol. But race is real, caffeine is ambiguous, cognition may or may not be at risk, and is a shortacting ccb a possibility. However, questions have been raised about atenolol. In patients with primary hypertension, atenolol is not better than placebo or no treatment for reducing cardiovascular morbidity or allcause mortality. Mean bp change with atenolol compared with alternatives ranged from. The authors stated that the use of atenolol as a reference drug in outcome trials of patients with hypertension may not be appropriate. Betablockers are less beneficial than other antihypertensive drugs in the elderly with hypertension. Lancet 2004, vol 364 no benefit to prevent mi or all.