Does atenolol differ from other beta-adrenergic blockers?
BACKGROUND
A recent meta-analysis of drug effects in patients with hypertension claims that all beta-adrenergic blockers are equally effective but less so than other antihypertensive drugs. Published comparisons of the beta-adrenergic blocker atenolol and non-atenolol beta-adrenergic blockers indicate different effects on death rates, arrhythmias, peripheral vascular resistance and prognosis post myocardial infarction, all in disfavor of atenolol. In keeping with these findings, the data presented in the meta-analysis indicate that atenolol is less effective than the non-atenolol beta-adrenergic blockers both when compared with placebo and with other antihypertensive drugs. These findings were not, however, statistically significant.


METHODS
We performed an additional analysis with a Bayesian statistical method in order to make further use of the published data.


RESULTS
Our calculations on the clinical data in the meta-analysis showed 13% lower risk (risk ratio 0.87) of myocardial infarction among hypertensive patients taking non-atenolol beta-adrenergic blockers than among hypertensive patients taking atenolol. The 90 % credibility interval ranged from 0.75 to 0.99, thereby indicating statistical significance. The probability of at least 10% lower risk (risk ratio </= 0.90), which could be considered to be of clinical interest, was 0.69.


CONCLUSIONS
Taken together with the other observations of differences in effects, we conclude that the claim that all beta-adrenergic blockers are inferior drugs for hypertensive patients should be rejected. Atenolol is not representative of the beta-adrenergic blocker class of drugs as a whole and is thus not a suitable drug for comparisons with other antihypertensive drugs in terms of effect. The non-atenolol beta-adrenergic blockers should thus continue to be fundamental in antihypertensive drug treatments.
Aursnes
Ivar
I
Department of Pharmacotherapeutics, University of Oslo, 0316 Blindern, Oslo, Norway. i.a.aursnes@medisin.uio.no
Osnes
Jan-Bjørn
JB
Tvete
Ingunn Fride
IF
Gåsemyr
Jørund
J
Natvig
Bent
B
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D001262:Atenolol / Q000627:therapeutic use*; D001499:Bayes Theorem; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000453:epidemiology; D015201:Meta-Analysis as Topic; D009203:Myocardial Infarction / Q000453:epidemiology / Q000517:prevention & control
D000319:Adrenergic beta-Antagonists; D001262:Atenolol