DOUBTS ON ATENOLOL

People taking atenolol should consider asking their doctor about the results of a recent study that says it is no better than placebo in treating high blood pressure or hypertension.

Results of a study in this week's issue of THE LANCET (p 1684) suggest that atenolol --- one of the most widely prescribed beta-blockers for reducing blood pressure may not be effective in reducing heart attacks or death from cardiovascular causes.

Atenolol is one of the most commonly used beta-blockers clinically, and has often been used as a reference drug in randomised controlled trials of high blood pressure. Concerns that atenolol may not be the best reference drug for comparison with other antihypertensive drugs led Bo Carlberg (Umea University Hospital, Sweden) and colleagues to systematically review the effect of atenolol on cardiovascular illness and death among patients with high blood pressure.

The investigators identified four studies that compared atenolol with placebo or no treatment, and five studies that compared atenolol with other antihypertensive drugs.

Atenolol was no different to placebo in terms of death from all causes, cardiovascular causes, or incidence of heart attack; a trend in reduced stroke incidence was the only favourable outcome. Atenolol slightly increased all-cause mortality compared with other antihypertensive drugs, in addition to showing a trend to increased cardiovascular death and increased stroke incidence. [Medical News Today]

These are serious and distressing results.

To claim that atenolol is as good as placebo is bad enough, but to say further that it "slightly increased all-cause mortality compared with other anti-hypertensive drugs, in addition to showing a trend to increased cardiovascular death and increased stroke incidence," is frightening.

Originally marketed by AstraZeneca as Tenormin in the 1980s, atenolol has been out of patent since 1991, and the market is full of cheaper versions of the drug.

Why is it as good as placebo?

The researchers suggest that atenolol does not permeate readily into the central nervous system, making it possibly less effective in controlling dangerous rhythm variations of the heart.

Other blood pressure drugs correct the malfunctioning of artery walls seen in people with high blood pressure, but atenolol does not. [Times Online]

What was AstraZeneca's reaction to this study?

AstraZeneca said it believed the research was inconclusive.

"Atenolol has been prescribed for many years and has millions of patient-years of experience behind it," a spokesman said. [Times Online]

Ask your cardiologist's opinion about it.

Businessmen, I've learned, care more for profits than public health.