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Incident CV rate similar with atenolol, metoprolol tartrate
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A study that compared the incidence of MI, stroke and HF in patients with hypertension who were newly prescribed two beta-blockers suggests there were no significant differences in CV events between patients who took atenolol or metoprolol tartrate.
Researchers used electronic medical records and health plan data from the Cardiovascular Research Network Hypertension Registry to compare incident CV events in patients who started first beta-blocker use between 2000 and 2009. A total of 120,978 patients without a history of CVD events started treatment.
Comparison of two drugs
During a median follow-up of 5.2 years, there were 3,517 incident MIs, 3,272 incident HF hospitalizations and 3,664 incident strokes. HRs were 0.99 for each of the three types of events. When the researchers used propensity score-matching methods, similar results were found.
The researchers concluded that there were no statistically significant differences in incident CV events between patients with hypertension who use atenolol or metoprolol tartrate.
“In addition, there were no statistically significant differences in systolic BP-lowering effects comparing atenolol and metoprolol tartrate,” Emily D. Parker, MPH, PhD, of HealthPartners Institute for Education and Research, Minneapolis, and colleagues concluded.
However, the researcher said these findings “should be interpreted cautiously, since there have been no trials comparing these two beta-blockers directly.”
In the study, atenolol was used by approximately 10 times more patients than metoprolol tartrate, according to the release.
Observational comparative effectiveness studies
In a related commentary, James S. Floyd, MD, MS, and Bruce M. Psaty, MD, PhD, from University of Washington, Seattle, wrote: “Although low-dose diuretics are the recommended first-line agent for pharmacologic therapy for uncomplicated high BP, several large trials funded by the pharmaceutical industry have used beta-blockers as the active-comparison control treatment, and the results of these trials suggest that other therapies are more effective than atenolol in preventing CV events, particularly stroke.
“While careful attention to study design is necessary for the results of observational comparative effectiveness studies to be credible, the high-quality answers may not involve the more important clinical questions, and the key clinical questions may not be susceptible to high-quality answers. For many or most comparative effectiveness questions related to drug therapies, double blinded randomized trials will be required to obtain high-quality evidence,” they wrote.
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Disclosure: This project was funded by a grant from the NHLBI and subcontract to HealthPartners Institute for Education and Research. Parker and colleagues report no relevant financial disclosures. Psaty and Floyd received grant support from the NHLBI.