meditation Question: Does atenolol ...

meditation Question: Does atenolol reduce cardiovascular morbidity and mortality in patients with hypertension? Setting: Various (meta-analysis)

subject of attention Design: Systematic review

Synopsis: The authors of this briefly described systematic review evaluated the purport of atenolol on cardiovascular morbidity and mortality in patients with hypertension. However, the search strategy may have prematurely restricted the field, causing the authors to miss potentially relevant studies. Their search strategy allowed them to include solely studies of atenolol versus placebo and five other studies that compared atenolol with other medicines More than 23,000 patients who were evaluated for an average of 46 years were involved in these studies.

Compared with placebo, atenolol lowered systolic descendants pressure by approximately 10 mm Hg and diastolic descendants pressure by 6 mm Hg Atenolol and the other medicines however, had approximately the same efficiency on lowering blood pressure. In the placebo-controlled trials, atenolol had no event on all-cause mortality, cardiovascular mortality, myocardial infarction, or visitation In the studies using other unsalable articles one study--the Losartan Intervention For Endpoint (LIFE) reduction in hypertension study--included as many patients as the quiet combined. The authors analyzed the studies with and without the LIFE data. When the LIFE application of mind was included, no significant differences in all-cause mortality, cardiovascular mortality, myocardial infarction, or blow were evident. When the LIFE data were not included, atenolol increased all-cause mortality (number privationed to treat to harm [NNH] = 110 for 46 years; 95 percent confidence interval [CI], 59 to 798) and attack (NNH = 79 for 46 years; 95 percent CI, 51 to 176)

The authors included several studies, including the LIFE trial, with questionable designs. united study was unblinded, two studies recruited patients with transient ischemic calamity or minor stroke, and the same included only patients with left ventricular hypertrophy Although greatest in number of the patients had hypertension, those studies were inappropriate to include as prevention trials. If these studies are exclud from the analysis, the authors' point that the data supporting the use of atenolol are limited is well taken.

Bottom Line: If these authors have identified all relevant research, it appears that atenolol is more effective than placebo in lowering life-blood pressure. It is not more effective than other medications, however. Furthermore, it does not appear to decrease the rates of cardiovascular morbidity or mortality. (Level of Evidence: 1a-)

meditation Reference: Carlberg B, et al. Atenolol in hypertension: is it a wise choice? Lancet November 6 2004;364:1684-9

Used with permission from Barry H Should atenolol be used for HTN? Accessed online December 28 2004 at: http://www.InfoPOEMs.com.

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