Atenolol May Not Protect Against Heart Disease

Atenolol one of the most widely used beta-blockers clinically may not protect against heart disease and actually may be harmful. "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," write Bo Carlberg, MD, from Umea University Hospital in Sweden, and colleagues. "However, questions have been raised about atenolol as the best reference drug for comparisons with other antihypertensives."

After searching The Cochrane Library, MEDLINE, and relevant textbooks, and after speaking with established researchers in hypertension, the investigators identified nine randomized controlled trials that determined the effect of atenolol on cardiovascular morbidity or mortality in patients with primary hypertension.

Four studies comparing atenolol with placebo or no treatment included 6,825 patients followed up for a mean of 4.6 years. Although there were major differences in blood pressure lowering, there were no outcome differences on all-cause mortality (relative risk [RR], 1.01; 95% confidence interval [CI], 0.89 to 1.15), cardiovascular mortality (RR, 0.99; 95% CI, 0.83 to 1.18]), or myocardial infarction (RR, 0.99; 95% CI, 0.83 to 1.19). However, the risk of stroke tended to be lower with atenolol than with placebo (RR, 0.85; 95% CI, 0.72 to 1.01).

Five trials comparing atenolol with other antihypertensive drugs consisted of 17,671 patients followed up for a mean of 4.6 years. Despite no major differences in blood pressure lowering between the treatment groups, the meta-analysis showed a significantly higher mortality (RR, 1.13; 95% CI, 1.02 to 1.25) with atenolol than with other active treatment. Cardiovascular mortality and stroke incidence also showed a trend to be higher with atenolol than with other antihypertensive drugs.

"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," coauthor Lars H. Lindholm, MD, also from Umea University Hospital in Sweden, says in a news release.

Losartan was superior to atenolol in a combined cardiovascular endpoint in the LIFE trial. Atenolol has not been demonstrated conclusively to improve cardiovascular outcomes compared with placebo, and it may increase the risk of mortality and stroke compared with other antihypertensive therapies.

Lancet. 2004;364:1684-1689

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