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Saturday, 6th November, 2004


Tenormin was no different to placebo in terms of death from all causes, cardiovascular causes, or incidence of heart attack.


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Results of a study in this week's issue of THE LANCET suggest that Atenolol (Tenormin?)--one of the most widely prescribed beta-blockers for reducing blood pressure--may not be effective in reducing heart attacks or death from cardiovascular causes.

Atenolol (Tenormin?) is one of the most commonly used beta-blockers clinically, and has often been used as a reference drug in randomized controlled trials of high blood pressure.

Beta-blockers work by competitively blocking beta-adrenergic receptors in the heart and juxtaglomerular apparatus. They lead to decreased heart rate, decreasing the work load by the heart. They do not produce coronary vasodilatation, but lead to a shift and redistribution of coronary circulation to the ischemic areas. It decreases the release of renin from the kidney, thus lowering blood pressure.

Study details

Concerns that Atenolol (Tenormin?) may not be the best reference drug for comparison with other antihypertensive drugs led Bo Carlberg (Umea University Hospital, Sweden) and colleagues to systematically review the effect of Atenolol (Tenormin?) on cardiovascular illness and death among patients with high blood pressure.

The investigators identified four studies that compared Atenolol (Tenormin?) with placebo or no treatment, and five studies that compared Atenolol (Tenormin?) with other antihypertensive drugs. The studies included some 24,000 patients followed for more than 4.5 years.

Atenolol (Tenormin?) was no different to placebo in terms of death from all causes, cardiovascular causes, or incidence of heart attack; a trend in reduced stroke incidence was the only favorable outcome. Atenolol (Tenormin?) slightly increased all-cause mortality compared with other antihypertensive drugs, in addition to showing a trend to increased cardiovascular death and increased stroke incidence.

In an interview with The Doctors Lounge, Carlberg said "We have not been able to show that Atenolol prevents cardiovascular disease in the same magnitude as many other antihypertensive drugs."

When we asked Dr. Carlberg whether his findings suggested that Atenolol use is dangerous, he replied: "No. Our study showed that Atenolol did not increase the risk of death compared with placebo." Co-author Lars H Lindholm comments: "We have some doubts about the suitability of Atenolol (Tenormin?) as a first-line antihypertensive drug and as a reference drug in outcome trials of hypertension." It should be noted that this is a retrospective analysis which needs to be confirmed by prospective randomized trial.


SOURCES: Carlberg, B. The Lancet, Nov. 6, 2004; vol 364: pp 1684-1689. Bo Carlberg, MD, PhD, department of public health and clinical medicine, Ume?University Hospital, Sweden.

Article reviewed by:

Dr. Tamer Fouad, M.D.

Edited by:

Dr. Russell Musthafa

Carolyn Merritt (Licensed Practical Nurse).

Reviewed by:

Dr. Yasser Mokhtar, M.D.

Theresa Jones (Registered Nurse).

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