Atenolol is associated with lower day-of-surgery heart rate compared to long- and short-acting metoprolol.
OBJECTIVE
The authors analyzed the association between outpatient β-blocker type and day-of-surgery (DOS) heart rate in ambulatory surgical patients. They further investigated whether differences in DOS heart rate between atenolol and metoprolol could be explained by once-daily versus twice-daily dosing regimens.


METHODS
Retrospective observational study.


METHODS
Veterans Administration hospital.


METHODS
Ambulatory surgical patients on long-term atenolol or metoprolol.


METHODS
None.


RESULTS
Using a propensity-score-matched cohort, DOS heart rates were compared in patients prescribed atenolol versus metoprolol. Then, once-daily and twice-daily metoprolol formulations were differentiated and DOS heart rates were compared within a general linear model. DOS heart rates in patients prescribed atenolol versus any metoprolol formulation were slower by a mean of 5.1 beats/min (66.6 v 71.7; 95% confidence interval [CI] of difference, 1.9-8.3; p = 0.002), a difference that was not observed in preoperative primary care visits. The general linear model showed that patients prescribed atenolol (typically once-daily dosing) had a mean DOS heart rate 5.6 beats/min lower compared with patients prescribed once-daily metoprolol succinate (68.9 v 74.5; 95% CI of difference, -8.6 to -2.6; p < 0.001) and 3.8 beats/min lower compared with patients prescribed twice-daily metoprolol tartrate (68.9 v 72.7; 95% CI of difference, -6.1 to -1.6; p < 0.001). DOS heart rates were similar between different formulations of metoprolol (95% CI of difference, -1.0 to +4.6; p = 0.22).


CONCLUSIONS
Atenolol is associated with a lower DOS heart rate versus metoprolol. The heart rate difference is specific to the day of surgery and is not explained by once-daily versus twice-daily dosing regimens.
Department of Anesthesiology, Yale University School of Medicine, New Haven, CT 06520-8051, USA. robert.schonberger@yale.edu
Robert B
RB
Schonberger
Cynthia
C
Brandt
Jessica
J
Feinleib
Feng
F
Dai
Matthew M
MM
Burg
D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D000368:Aged; D000556:Ambulatory Surgical Procedures; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001262:Atenolol / Q000008:administration & dosage / Q000627:therapeutic use*; D002626:Chemistry, Pharmaceutical; D015331:Cohort Studies; D016001:Confidence Intervals; D003692:Delayed-Action Preparations; D005260:Female; D006339:Heart Rate / Q000187:drug effects*; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D016018:Least-Squares Analysis; D016014:Linear Models; D008297:Male; D008790:Metoprolol / Q000008:administration & dosage / Q000627:therapeutic use*; D008875:Middle Aged; D010045:Outpatients; D010349:Patient Compliance; D057216:Propensity Score; D016896:Treatment Outcome
D000319:Adrenergic beta-Antagonists; D000959:Antihypertensive Agents; D003692:Delayed-Action Preparations; D001262:Atenolol; D008790:Metoprolol