Study Finds No Significant Differences in CV Event Rates With Two Popular Beta-Blockers Used to Treat Hypertension

A new study published on Oct. 8 in the Archives of Internal Medicine found no statistically significant differences in the rate of cardiovascular events in hypertensive patients without a history of cardiovascular disease (CVD) starting beta-blocker treatment with either atenolol or metoprolol tartrate.

The study, which looked at 120,978 patients without history of CVD from the Cardiovascular Research Network Hypertension Registry between 2000 and 2009, found no differences between the two drugs in rates of incident myocardial infarction, heart failure or stroke after adjusting for potential confounders. In addition, there were no statistically significant differences in systolic blood pressure-lowering effects comparing atenolol and metoprolol tartrate, according to the study authors. However, there was a small but statistically significant difference in change in diastolic blood pressure (5.9 and 5.5 mm Hg for atenolol and metoprolol tartrate, respectively P = .005).

The authors did note several potential limitations and caveats with the observational study, one such limitation being an inability to compare atenolol with any beta-blocker other than metoprolol tartrate given the low use of other agents among the study population. The authors suggest, for example, that "the use of metoprolol succinate, a once-daily drug that may have better adherence rates compared with twice-daily metoprolol tartrate, has been increasing owing to the availability of generic versions in recent years."

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That being said, the authors said similar studies using large registries liked the one used in this analysis may be useful for addressing comparative effectiveness questions like this that are unlikely to be resolved by randomized trials.

Meanwhile, an associated commentary calls the study a well-designed comparative effectiveness study, but calls into question its clinical value, given that beta-blockers "have lost favor as first-line agents for the treatment of hypertension." The commentary authors go on to suggest that the "current question of primary interest is whether health outcomes associated with the use of hydrochlorothiazide and chlorthalidone may differ."

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