Atenolol in hypertension journal of association of. Guideline update, clinical report by journal of family practice. Medical research council trial of treatment of hypertension in older adults. What we really need to do to reduce cardiovascular events in hypertensive patients. The lessthanadequate effect of betablockers in lowering the blood pressure and on vascular protection, and the unfavorable effects of these drugs, as. Our results cast doubts on atenolol as a suitable drug for hypertensive patients. The authors concluded that atenolol may not be a suitable treatment option for patients with hypertension, and queried its use as a reference drug in trials. Verify effective contraception in women of childbearing potential. When not to use betablockers in seniors with hypertension. All elderly patients in ontario, canada population over 3. It differs from pindolol and proponolol in that it does not have an intrinsic sympathomimetic action or. Optimal use of betablockers in highrisk hypertension. Promoting evidencebased prescribing pharmacy services.
Some national guidelines on hypertension have demoted betablockers from a first choice to a fourth choice treatment. Atenolol is a beta blocker medication primarily used to treat high blood pressure and heartassociated chest pain. An application to recommend that the representative of the beta. Twelve patients whose mood pressure was not wellcontrolled on methyldopa and chlorthalidone and 11 patients who were treated previously with other betablockers all benefited from atenolol which appeared to be effective and welltolerated. Health, general adrenergic beta blockers dosage and administration adrenergic betaantagonists aged patients drug therapy elderly patients hypertension. The chemical works by slowing down the heart and reducing its workload.
The authors also carried out a metaanalysis of five trials 17,671 patients comparing atenolol with other antihypertensive agents. There are many classes of antihypertensives, whichby varying meansact by lowering blood pressure. Recent evidence suggests that central blood pressure is a more important determinant of cardiovascular risk than brachial pressure. Analysis of atenolol for hypertension suggests that the medication does not carry cardiac benefits, and may not be the best choice for patients with high blood pressure. However, compared with other antihypertensive drugs, it may increase the risk for stroke or death. Hydralazine and its derivatives are also used in the treatment of severe hypertension, although they should be avoided in emergencies. It can be useful in the management of other conditions, however, and evidence does not support a recommendation to remove it from the market entirely. A daily nitrate free interval of at least 14 hours is advisable to minimize tolerance. Rate control atenolol 25100 mg daily diltiazem er 180360 mg daily. Are there big differences among betablockers in treating. However, compared to other antihypertensive drugs, it may increase the risk of stroke or death. Openurl1crossref2pubmed3web of science4 q in patients with essential hypertension, does atenolol reduce cardiovascular morbidity or all cause mortality. Lukes medical and other major medical centers said that the vasodilating beta blockers should be the only ones used if a beta blocker is the choice. In patients with essential hypertension, atenolol is not better than placebo or no treatment for reducing cardiovascular morbidity or all cause mortality.
Evidence suggests that atenolol is less effective than certain other betablockers and drugs from other pharmacologic classes in reducing cardiovascular risk when used to treat hypertension. Use of betablockers for uncomplicated hypertension in the. What we really need to do to reduce cardiovascular events. Atenolol has fared the worse in comparison to some beta blockers, the researchers and doctors from st. Choice of drug therapy in primary essential hypertension. It can also be used with other blood pressure medications. In contrast, the 2007 guidelines of the european society of hypertension european society of cardiology eshesc retain them among the drug classes used to initiate and maintain antihypertensive treatment, together with diuretics, angiotensinconverting. The efficacy of atenolol given once daily was assessed in 41 otherwise healthy hypertensive patients over a period of six months. Antihypertensive drug wikipedia republished wiki 2. Betablockers have been found not to be effective for primary prevention of cardiovascular disease in patients with primary hypertension. The problem was first recognized by messerli et al. Priority updates from the research literature from the family physicians inquiries network, case study, clinical report by journal of family practice.
In patients with hypertension and left ventricular hypertrophy in the life study, there were significantly higher risks, adjusted for the framingham risk score, for the primary composite end point, stroke, and total mortality in the highest versus lowest quartile of pulse pressure with atenolol based treatment. Interestingly, antihypertensive drugs exert different effects on brachial and central pressure. Lancet 2004, vol 364 no benefit to prevent mi or all. It differs from pindolol and proponolol in that it does not have an intrinsic sympathomimetic action or membrane stabilising activity. Betablockers are less beneficial than other antihypertensive drugs in the elderly with hypertension. Health, general cardiovascular diseases prevention hypertension care and treatment practice guidelines medicine. Should beta blockers remain first choice in the treatment of primary. More doubts cast on betablockers as first choice in uncomplicated hypertension results of a new metaanalysis suggest that the era of beta blockers for hypertension is over and further analysis of the newly unblinded hypertension assignments in ascot pair the 2002 lipidlowering arm results supporting atorvastatin with the 2005 blood pressurelowering arm results endorsing. Although treatment with atenolol may no longer be a wise choice in patients with hypertension and high pp, 8,25 losartanbased treatment appears to offer powerful cardiovascular protection to these. They pointed out the significantly lesser benefit of betablocker therapy in 2 trials versus.
But race is real, caffeine is ambiguous, cognition may or may not be at risk, and is a shortacting ccb a possibility. However, questions have been raised about atenolol as the best reference drug for. Accumulated evidence suggests that atenolol is not sufficiently effective as a primary tool to treat hypertension. Sign in here to access free tools such as favourites and alerts, or to access personal subscriptions. A new metaanalysis has raised doubts about the suitability of atenolol as a firstline antihypertensive drug and as a reference drug in outcome trials of hypertension. Should beta blockers remain first choice in the treatment of primary hypertension.
Antihypertensives are a class of drugs that are used in medicine and pharmacology to treat hypertension high blood pressure. It is possible that the controversy with betablockers arises because atenolol. Achieved reductions in sbp, dbp, and pp could not explain the differences in cardiovascular outcomes between treatment groups in the life study. Moreover, they challenge the use of atenolol as a reference drug in outcome trials in hypertension. Effects of different regimens to lower blood pressure on major cardiovascular events in older and younger adults. Betablockers in the management of hypertension andor. Pulse pressure and effects of losartan or atenolol in.
For full access to this pdf, sign in to an existing account, or purchase an annual subscription. Introduced in 1976, atenolol was developed as a replacement for propranolol in the treatment of hypertension. Current strategies in hypertension current strategies. Indeed, the carlberg metaanalysis demonstrated the inferiority of atenolol in preventing cardiovascular events when compared to. 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. Reducing heart rate with beta blockers in hypertension is. They are no longer indicated as firstline therapy for high blood pressure due to side effects and safety concerns, but hydralazine remains a drug of choice in gestational hypertension.
How i treat patients with elevated blood pressure elevated blood pressure, or hypertension, is associated with serious health problems, such as strokes, heart attacks, and kidney failure. Abstract and commentary also appear in acp journal club. Atenolol is a beta blocker medication primarily used to treat high blood pressure and. Atenolol is one of the most widely used beta blockers clinically, and has often been used as a reference drug in randomised. Clinical impact ratings gpfpprimary care q imambulatory care w cardiology wwqq. Mean reduction in blood pressure bp attributed to atenolol ranged from 4. Other uses include the prevention of migraines and treatment of certain irregular heart beats.
This has been confirmed by a 2007 cochrane analysis. Antino action of carvedilol in cellfree system and in vascular. In patients with primary hypertension, atenolol is not better than placebo or no treatment for reducing cardiovascular morbidity or allcause mortality. Comments to the 2007 recommendations for the treatment of.
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