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).
good link – i tend to write a lot of scripts for atenolol.
Comment by Dr. Charles — November 17, 2004 @ 8:32 pm
This does bring an interesting trend to the table for discussion: sabotaguing the generic because no one will support the cost of a study that refutes the meta-analysis. In medicine truth rarely is evident, it seems we are left to rumor and inuendo that will ask us to abandon inexpensive meds for the ones that are marketed aggressively. I suppose all of the theoretical weaknesses and bias of meta-analysis are relevant in this study?
Comment by J.M.Pontious MD — November 19, 2004 @ 5:58 pm
I agree that there is a strong incentive for brand manufacturers to sabotage generic drugs. In this case, however:
- There is a generic alternative to atenolol: generic metoprolol. Even though there are some theoretical reasons to prefer the longer acting Toprol XL to shorter acting metoprolol, plain old metoprolol is the drug that has been used in previous beta-blocker trials and may well be preferable to atenolol.
- As to the drawbacks of meta-analyses, in this case the article can be looked at more as a graphic summary of several trials than as a typical pooling-of-results type meta-analysis, which is why I found it to be rather convincing.
Comment by mjmd — November 19, 2004 @ 7:27 pm
If the majority of subjects in the 4 studies comprising the meta-a were elderly, many probably had systolic hypertension. This is a condition not well treated with beta-blockers such as atenolol (no alpha (vasodilator) receptor blockade).
Comment by Dr. R. Kutnick — November 21, 2004 @ 12:50 pm
The mean age in the four atenolol vs. placebo trials was 70; in the five trials looking at atenolol vs. other hypertensives it was 63. Whether or not that qualifies as elderly I will leave up to the reader.
Comment by mjmd — November 21, 2004 @ 2:40 pm
Could it be now that all beta-blockers are NOT created equal? There’s such a huge push these days to bash “brand name” meds due to cost. Is it not true that at one time all generics were “brand name” and many have been replaced due to improvements in medicine? Why will people pay hundreds of dollars a month on cigarettes, junk food and alcohol, but expect the medicines that keep them from dying to be free?
Comment by Brad Jorgensen — December 1, 2004 @ 12:06 am
My problem with the ads is that they are almost all for high priced medications that drive up costs for everyone with insurance. Because generics can’t be effectively advertised by brand name, there is no level field.
So – I wouldn’t mind the Celebrex ads if there also were ads telling us about “600 mg prescription Ibuprofen – nothing proven more effective or safer in its class. Take the pill you know won’t be taken off the market next.”
And I wouldn’t mind Nexium ads if there also were ads telling us about how “prescription omeprazole is preferred over Nexium by all three Harvard med school professors who have published books on the pharmaceutical industry.”
As for the Crestor commercials, they wouldn’t be nearly as bad if there was also one telling us about how “time-tested lovastatin is preferred for first-line treatment over Crestor by 4 out of 5 medical bloggers.”
It‘s as if there were no ads for Chevies, only for Mercedes — and, through an insurance scheme, even Chevy buyers had to pay more when the neighbor buys a Mercedes. So long as the pharmaceutical business is structured so that generics can’t be effectively advertised, it isn’t in the public interest to allow ads for meds under patent either.
By the way, I’m just a patient. I know squat about medicine, but a little more about history of medicine.
Comment by Steven Eisenberg — December 10, 2004 @ 9:58 pm
Hello I’m a resident in Int Med, with regards to the article: Atenolol is it a wise choice for treating HTN?
It turns out that my partner will be presenting this article at journal club next week and I also must present an article that is related to this article, either one that correlates with or goes against it. Your suggestions would help greatly.
Dr Patel 1/24
Comment by Kevin Patel — January 24, 2005 @ 10:14 pm
Like Steven Eisenberg, I too am merely a patient who has been prescribed Atenolol for something over 18 months now. I feel no benefit from taking this medicine, and repeat tests show my blood pressure to be equally as high now as it was before I began taking the medication. Initially my BP dropped to a more acceptable level, but it has reversed itself and is now climbing again despite my desperate efforts to a) lose weght( I need to lose at least 1 and a half stone) and b) exercise more (I now walk a mile and a half daily every lunchtime).
I am always slightly suspicious of brand name medications as they seem to be marketed very aggressively, but under the NHS scheme here in the UK it would make no difference to me which were prescribed as I would still have to pay the standard £5 per item charge every time.
I just dislike the way some drugs are automatically chosen over others. Is this because of the way drug companies market them and not because of efficacy?
Anyone got an answer please?
Comment by Pam Saunders — January 30, 2005 @ 3:13 pm
I may be the exception. I was prescribed Norvasc for my hypertension which is very high priced, and did virtually nothing. Then, I was prescribed Atacand HCT (which is a receptor blocker), which seemed to do a fair job at a high price. I still woke up with pounding tacycardia in the morning, as if I had been running a mile, with my HB nearing 100 BPM.
Then, I was prescribed the very affordable Atenolol. I take it before bed time, and wham, I get the blood pressure of a child, and the slow heartbeat of an athelete, and the tachcardia problem is gone! It is true that the low dosage is short lived, but I do not need it for 24 hrs, because my heart rate and BP rise higher at night and upon awakening.
The funny thing is, my cat had tachycardia also, the vet prescribed Atenolol for her also, and it worked just great for my cat as well! Well, I am only 49, so what works well on me may not work as well on older people, but this is my experience. So far, I am very happy with the Atenolol.
Comment by C. Bloom — February 15, 2005 @ 9:11 pm
Thought I’d give a quick perspective to this thread. I am a young user of atenolol…turning 36 next month. However, my family has a genetic history of high heart rate. (Tachycardia) It has come on slowly since college. There is no other history of unusual or morbid heart disease in my family.
A few years ago, when excercising on newer heart-rate monitoring equipment, I became frustrated, as the machine would not let me continue at my configured profile! I had to re-enter my age as 18 to allow the high heart rates I was reaching. Eventually, my resting heart rate continued to climb, and even though I am a very fit person, I started taking beta blockers.
I started on Zebeta (Bisoprolol Fumarate), and eventually switched to Atenolol recently. Zebeta was quite expensive, even the generic. Eventually, my insurance carrier refused to cover it. I can attest to the action of this class of drugs. The blocking of the adrenaline action on cardiac muscle is impossible to ignore. (My issue has been compared to an adrenaline “leak” in an otherwise normal system.) However, I am not personally familiar taking the drug for other heart related issues. (When the heart can’t support the amount of action asked of it by the system?) Just thought I’d mention the other obvious use of this class of drugs.
Comment by Dave G. — February 19, 2005 @ 11:35 pm
I have been taking atenolol for many years and am 66. This medication was the only one I found to reduce my high blood pressure without undesirable side effects. I tried some that gave me headaches and none that reduced my blood pressure until atenolol. One thing I had to do was take the medication twice a day, morning and night, to hold the pressure down. It does not seem to last all of 24 hours. It is inexpensive and effective. What more could you ask?
Comment by Fern Reese — May 21, 2005 @ 9:17 am
I was taking Atenolol for the last five years for tachycardia. it worked very well but I developed psoriasis on my hands and heard beta blockers worsened the condition. My Doctor relutantly switched me to Cardizem Cd. I started this medication on May May 26 and it was awful. My blood pressure shot up to 168/100 and my pulse which was at 68 on atenolol went up to 90 to 100 bpm. I threw away the Cardizem and went back on atenolol.Today May 29 my b.p. is 138/84 and pulse at 73. Thank God for atenolol. I think it’s interesting that Atenolol has been out since 1981-25 year record which until recently was excellent. It cost me $5.00 for a 90 day supply from my company mail order. Wonder if the fact that it is now a generic makes it such a bad choice when compared to the newer very expensive drugs
Comment by patton west — May 29, 2005 @ 2:40 pm
Having received a number of comments about atenolol that make it sound as if I am arguing against generic medication, I just want to re-emphasize that this is not the case. I am not against generics, and I am not sure that atenolol isn’t a good choice for many people.
I just think this study points out that, much as we might like to, we shouldn’t automatically assume that a generic medication in the same class as other drugs will necessarily translate to the same benefits. It might, and it probably usually will, but we need to at least consider the possibility that this will not be the case. Certainly, the shorter half-life of atenolol should be taken into account, and dosing schedules perhaps adjusted accordingly.
Comment by mjmd — May 30, 2005 @ 2:51 pm
I prescribed Atenolol for thousands of my patients,it is excellent for hypertension, but it loses its cardio-selectivity upon increasing of doses.
Comment by Badheeb — June 17, 2005 @ 2:57 am