From: KutchScienceFoundation

Doubts over blood pressure drug http://news.bbc.co.uk/1/hi/health/3981935.stm A
drug commonly prescribed to lower blood pressure is not be effective in reducing
cardiovascular deaths and heart attacks, research suggests.

Lancet 2004; 364: 1684-89 ( Atenolol in hypertension: is it a wise choice? )
http://www.thelancet.com/search/search.isa

Department of Public Health and Clinical Medicine, Umeå University Hospital, SE
901 85 Umeå, Sweden (B Carlberg MD, Prof L H Lindholm MD); and Department of
Nephrology, Sahlgrenska University Hospital, Göteborg, Sweden (O Samuelsson MD)

Correspondence to: Prof Lars H Lindholm LarsHLindholm@fammed. umu.se
Summary




Background Atenolol is one of the most widely used ßblockers clinically, and has
often been used as a reference drug in randomised controlled trials of
hypertension. However, questions have been raised about atenolol as the best
reference drug for comparisons with other antihypertensives. Thus, our aim was
to systematically review the effect of atenolol on cardiovascular morbidity and
mortality in hypertensive patients.

Methods Reports were identified through searches of The Cochrane Library,
MEDLINE, relevant textbooks, and by personal communication with established
researchers in hypertension. Randomised controlled trials that assessed the
effect of atenolol on cardiovascular morbidity or mortality in patients with
primary hypertension were included.

Findings We identified four studies that compared atenolol with placebo or no
treatment, and five that compared atenolol with other antihypertensive drugs.
Despite major differences in blood pressure lowering, there were no outcome
differences between atenolol and placebo in the four studies, comprising 6825
patients, who were followed up for a mean of 4·6 years on all-cause mortality
(relative risk 1·01 [95% CI 0·89-1·15]), cardiovascular mortality (0·99
[0·83-1·18]), or myocardial infarction (0·99 [0·83-1·19]). The risk of stroke,
however, tended to be lower in the atenolol than in the placebo group (0·85
[0·72-1·01]). When atenolol was compared with other antihypertensives, there
were no major differences in blood pressure lowering between the treatment arms.
Our meta-analysis showed a significantly higher mortality (1·13 [1·02-1·25])
with atenolol treatment than with other active treatment, in the five studies
comprising 17671 patients who were followed up for a mean of 4·6 years.
Moreover, cardiovascular mortality also tended to be higher with atenolol
treatment than with other antihypertensive treatment. Stroke was also more
frequent with atenolol treatment.

Interpretation Our results cast doubts on atenolol as a suitable drug for
hypertensive patients. Moreover, they challenge the use of atenolol as a
reference drug in outcome trials in hypertension.

Forwarded By Dr.BHUDIA-Science Group Of INDIA.
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