Time to reconsider atenolol?

In the November 3 Lancet is a meta-analysis entitled “Atenolol for hypertension: is it a wise choice?“.

When compared to placebo for the treatment of hypertension (4 trials with about 3,000 patients total), there was no benefit for atenolol in terms of mortality, cardiovascular mortality or MI. There was a benefit for stroke, but this was mainly from one trial in which atenolol was not used as monotherapy in most patients.

In 3 trials with about 7,000 patients that compared atenolol to other anti-hypertensives, atenolol fared worse than the other medications for all parameters except for MI, where it was about the same.

The authors speculate that the non-lipophilic nature of atenolol (unlike metoprolol and others) might play a role, as might a lesser or absent influence on LVH, compared with other medications. They note that there have been no good trials comparing different beta-blockers in hypertension, thus this need not apply to other beta-blockers. And, of course, beta-blockers have an important role to play in the setting of ischemic heart disease, CHF and arrhythmias.

I’m not a big fan of meta-analyses, in general, but this one is intriguing, and does make atenolol seem much less attractive for hypertension (and perhaps for other indications as well).

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