Review: Atenolol may be ineffective for reducing cardiovascular morbidity or all-cause mortality in primary hypertension

摘要

QuestionnIn patients with primary hypertension, does atenolol reduce cardiovascular morbidity or all-cause mortality?nnMethodsnnData sources: The Cochrane Library, MEDLINE, relevant textbooks, and researchers in hypertension.nnStudy selection and assessment: Randomized controlled trials (RCTs) that assessed the effect of atenolol (as the sole first-line drug in 1 of the treatment groups) on cardiovascular morbidity or mortality in patients with primary hypertension. Studies were also required to have predefined criteria for myocardial infarction, stroke, and cardiovascular death.nnOutcomes: Myocardial infarction, stroke, cardiovascular mortality, and all-cause mortality.nnnMain resultsnn8 RCTs met the selection criteria. 1 of the 8 RCTs had 3 arms corresponding to treatment with atenolol, a thiazide diuretic, or placebo. 2 major comparisons were made. Atenonol compared with placebo or with untreated controls (4 RCTs, n = 6825): Mean reduction in blood pressure (BP) attributed to atenolol ranged from 4.0 to 18.0 mm Hg systolic and 2.9 to 11.0 mm Hg diastolic. The groups did not differ for myocardial infarction, stroke, cardiovascular mortality, or all-cause mortality (Table). Atenolol compared with other antihypertensive drugs (5 RCTs, n = 17 671): Comparison antihypertensive drugs included hydrochlorothiazide or bendroflumethiazide (1 RCT), hydrochlorothiazide (1 RCT), captopril (1 RCT), losartan (1 RCT), and lacidipine (1 RCT). Mean BP change with atenolol compared with alternatives ranged from −1.0 to 1.1 mm Hg systolic and −1.0 to 0.5 mm Hg diastolic. The rates of stroke and cardiovascular and all-cause mortality were greater in the atenolol group than in the other antihypertensive drug group (Table). The groups did not differ for rates of myocardial infarction (Table).