Comparative Effectiveness of 2 β-Blockers in Hypertensive Patients

Study Questions:

What is the comparative effectiveness of atenolol and metoprolol tartrate for the primary prevention of cardiovascular outcomes in patients with treated hypertension?

Methods:

This was a retrospective cohort study nested within the hypertension registry of the Cardiovascular Research Network. Patients had no history of cardiovascular disease (CVD) and had not previously filled a prescription for beta-blocker. The associations of new use of atenolol and metoprolol tartrate with incident myocardial infarction (MI), heart failure (HF), and stroke were examined.

Results:

The hazard ratios for MI, HF, and stroke in patients using metoprolol tartrate for the treatment of hypertension were 0.99 (95% confidence interval [CI], 0.97-1.02), 0.99 (95% CI, 0.96-1.01), and 0.99 (95% CI, 0.97-1.02), respectively. Propensity score matching (used to minimize the effects of confounding by indication) yielded similar results.

Conclusions:

In this observational study comparing patients without known CVD, there was no difference in incident CV events in those who initiated therapy with either metoprolol tartrate or atenolol.

Perspective:

Although limited by a retrospective study design and the potential impact of unmeasured confounding in administrative data, the current study offers insight into the comparative effectiveness of atenolol and metoprolol tartrate for primary prevention. While recent literature has implicated the limitations of beta-blocker therapy for the management of uncomplicated hypertension, most evidence comes from the use of atenolol and the question of whether trial outcomes are simply related to this particular drug (versus a class effect) has largely been unanswered. Although this study may indicate that the unfavorable trial data associated with atenolol may apply to metoprolol tartrate, the fact remains that no primary prevention trial has compared atenolol head-to-head with other beta-blockers.

Clinical Topics: Heart Failure and Cardiomyopathies, Prevention, Acute Heart Failure, Heart Failure and Cardiac Biomarkers, Hypertension

Keywords: Incidence, Myocardial Infarction, Stroke, Heart Failure, Antigens, CD56, Cardiovascular Diseases, Hypertension, Stem Cell Factor, Primary Prevention


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