Atenolol :: therapeutic use
Latest Paper:
Mesh-terms: Aconitine :: analogs & derivatives; Aconitine :: therapeutic use; Acupuncture Therapy; Adult; Anti-Arrhythmia Agents :: therapeutic use; Atenolol :: therapeutic use; Atrial Fibrillation :: drug therapy; Atrial Fibrillation :: therapy; Exercise; Female; Humans; Male; Metoprolol :: therapeutic use; Middle Aged; Moricizine :: analogs & derivatives; Moricizine :: therapeutic use; Reflexotherapy;
Most cited papers:
Björn Dahlöf,
Richard B Devereux,
Sverre E Kjeldsen,
Stevo Julius,
Gareth Beevers,
Ulf de Faire,
Frej Fyhrquist,
Hans Ibsen,
Krister Kristiansson,
Ole Lederballe-Pedersen,
Lars H Lindholm,
Markku S Nieminen,
Per Omvik,
Suzanne Oparil,
Hans Wedel
Sterling Rock Falls Clinic, 101 East Miller Road, Sterling, IL 61081, USA. pptoth@essex1.com
BACKGROUND: Blood pressure reduction achieved with beta-blockers and diuretics is the best recorded intervention to date for prevention of cardiovascular morbidity and death in patients with hypertension. Left ventricular hypertrophy (LVH) is a strong independent indicator of risk of cardiovascular morbidity and death. We aimed to establish whether selective blocking of angiotensin II improves LVH beyond reducing blood pressure and, consequently, reduces cardiovascular morbidity and death. METHODS: We did a double-masked, randomised, parallel-group trial in 9193 participants aged 55-80 years with essential hypertension (sitting blood pressure 160-200/95-115 mm Hg) and LVH ascertained by electrocardiography (ECG). We assigned participants once daily losartan-based or atenolol-based antihypertensive treatment for at least 4 years and until 1040 patients had a primary cardiovascular event (death, myocardial infarction, or stroke). We used Cox regression analysis to compare regimens. FINDINGS: Blood pressure fell by 30.2/16.6 (SD 18.5/10.1) and 29.1/16.8 mm Hg (19.2/10.1) in the losartan and atenolol groups, respectively. The primary composite endpoint occurred in 508 losartan (23.8 per 1000 patient-years) and 588 atenolol patients (27.9 per 1000 patient-years; relative risk .87, 95% CI .77- .98, p= .021). 204 losartan and 234 atenolol patients died from cardiovascular disease ( .89, .73-1.07, p= .206); 232 and 309, respectively, had fatal or non-fatal stroke ( .75, .63- .89, p= .001); and myocardial infarction (non-fatal and fatal) occurred in 198 and 188, respectively (1.07, .88-1.31, p= .491). New-onset diabetes was less frequent with losartan.Interpretation Losartan prevents more cardiovascular morbidity and death than atenolol for a similar reduction in blood pressure and is better tolerated. Losartan seems to confer benefits beyond reduction in blood pressure.
Mesh-terms: Aged; Aged, 80 and over; Antihypertensive Agents :: therapeutic use; Atenolol :: therapeutic use; Cardiovascular Diseases :: mortality; Cardiovascular Diseases :: prevention & control; Comparative Study; Diabetes Mellitus :: complications; Double-Blind Method; Female; Human; Hypertension :: drug therapy; Losartan :: therapeutic use; Male; Middle Aged; Receptors, Angiotensin :: antagonists & inhibitors; Support, Non-U.S. Gov't;
BACKGROUND: Perioperative myocardial ischemia is the single most important potentially reversible risk factor for mortality and cardiovascular complications after noncardiac surgery. Although more than 1 million patients have such complications annually, there is no effective preventive therapy. METHODS: We performed a randomized, double-blind, placebo-controlled trial to compare the effect of atenolol with that of a placebo on overall survival and cardiovascular morbidity in patients with or at risk for coronary artery disease who were undergoing noncardiac surgery. Atenolol was given intravenously before and immediately after surgery and orally thereafter for the duration of hospitalization. Patients were followed over the subsequent two years. RESULTS: A total of 200 patients were enrolled. Ninety-nine were assigned to the atenolol group, and 101 to the placebo group. One hundred ninety-four patients survived to be discharged from the hospital, and 192 of these were followed for two years. Overall mortality after discharge from the hospital was significantly lower among the atenolol-treated patients than among those who were given placebo over the six months following hospital discharge ( vs. 8 percent, P< .001), over the first year (3 percent vs. 14 percent, P= .005), and over two years (10 percent vs. 21 percent, P= .019). The principal effect was a reduction in deaths from cardiac causes during the first six to eight months. Combined cardiovascular outcomes were similarly reduced among the atenolol-treated patients; event-free survival throughout the two-year study period was 68 percent in the placebo group and 83 percent in the atenolol group (P= .008). CONCLUSIONS: In patients who have or are at risk for coronary artery disease who must undergo noncardiac surgery, treatment with atenolol during hospitalization can reduce mortality and the incidence of cardiovascular complications for as long as two years after surgery.
Mesh-terms: Administration, Oral; Adrenergic beta-Antagonists :: therapeutic use; Adult; Aged; Atenolol :: therapeutic use; Disease-Free Survival; Double-Blind Method; Heart Diseases :: mortality; Heart Diseases :: prevention & control; Human; Injections, Intravenous; Middle Aged; Postoperative Complications :: mortality; Postoperative Complications :: prevention & control; Premedication; Risk Factors; Support, Non-U.S. Gov't; Surgical Procedures, Operative; Survival Analysis;
Mesh-terms: Adrenergic beta-Antagonists :: therapeutic use; Arousal :: drug effects; Atenolol :: therapeutic use; Behavior Therapy; Epinephrine :: diagnostic use; Human; Interpersonal Relations; Panic :: drug effects; Phenelzine :: therapeutic use; Phobic Disorders :: diagnosis; Phobic Disorders :: drug therapy; Phobic Disorders :: psychology; Social Environment;
MRC Multidisciplinary Research Group on Hypertension, Clinical Research Institute of Montreal, Quebec, Canada.
Seventeen male untreated mild essential hypertensive patients aged 41 +/- 2 years agreed to participate in a double-blind randomized trial to test the effects of antihypertensive treatment on the structure and function of subcutaneous resistance arteries. Patients were treated with either 50 to 100 mg/d atenolol or 2.5 to 5 mg/d cilazapril. Blood pressure before treatment was 148 +/- 6/99 +/- 1 and 147 +/- 2/99 +/- 1 mm Hg, respectively. At 1 year of treatment blood pressure was 131 +/- 4/85 +/- 2 and 132 +/- 2/87 +/- 1 mm Hg, respectively. Resistance arteries (200 to 400 microns lumen diameter) dissected from subcutaneous gluteal biopsies obtained before treatment and at 1 year showed that the media-lumen ratio of arteries from patients treated with cilazapril was reduced to 6.31 +/- .21% from 7.54 +/- .31% before treatment (P <.05), still slightly but significantly larger (P <.05) than the media-lumen ratio of resistance arteries of normotensive control subjects (5.15 +/- .30%). In contrast, in arteries from patients treated with atenolol there was no significant change with treatment (7.97 +/- .60% before and 8.07 +/- .45% after 1 year of treatment). Active wall tension responses to endothelin-1 were blunted in hypertensive patients and normalized in the cilazapril-treated patients. Depressed active media stress responses to norepinephrine, arginine vasopressin, and endothelin-1 were accordingly normalized in the patients receiving cilazapril as the media width became thinner but were unchanged in those taking atenolol.(ABSTRACT TRUNCATED AT 250 WORDS)
Mesh-terms: Adult; Arteries :: drug effects; Arteries :: pathology; Arteries :: physiopathology; Atenolol :: pharmacology; Atenolol :: therapeutic use; Blood Pressure :: drug effects; Cilazapril :: pharmacology; Cilazapril :: therapeutic use; Double-Blind Method; Human; Hypertension :: drug therapy; Hypertension :: pathology; Hypertension :: physiopathology; Male; Middle Aged; Support, Non-U.S. Gov't;
C J Pepine,
P F Cohn,
P C Deedwania,
R S Gibson,
E Handberg,
J A Hill,
E Miller,
R G Marks,
U Thadani
University of Florida, Gainesville.
BACKGROUND: Detection of asymptomatic ischemia in patients with coronary artery disease has been associated with increased risk for adverse outcome, but treatment of patients with asymptomatic ischemia remains controversial. Accordingly, the purpose of this study was to determine if treatment reduces adverse outcome in patients with daily life ischemia. METHODS AND RESULTS: A multicenter, randomized, double-blind, placebo-controlled study of asymptomatic or minimally symptomatic outpatients with daily life silent ischemia due to coronary artery disease was conducted. The primary outcome measure was event-free survival at 1 year by Kaplan-Meier analysis. Events were death, resuscitated ventricular tachycardia/fibrillation, myocardial infarction, hospitalization for unstable angina, aggravation of angina, or revascularization. The secondary outcome was ischemia during ambulatory ECG monitoring at 4 weeks. Three hundred six outpatients with mild or no angina (Canadian Cardiovascular Society class I or II), abnormal exercise tests, and ischemia on ambulatory monitoring were randomized to receive either atenolol (100 mg/d) or placebo. After 4 weeks of treatment, the number (mean +/- SD, 3.6 +/- 4.2 versus 1.7 +/- 4.6 episodes, P <.001) and average duration (30 +/- 3.3 versus 16.4 +/- 6.7 minutes, P <.001) of ischemic episodes per 48 hours of ambulatory monitoring decreased in atenolol- compared with placebo-assigned patients (4.4 +/- 4.6 to 3.1 +/- 6. episodes and 36.6 +/- 4.1 to 30 +/- 5.5 minutes). Event-free survival improved in atenolol-treated patients (P <.0066), who had an increased time to onset of first adverse event (120 versus 79 days) and fewer total first events compared with placebo (relative risk, .44; 95% confidence intervals, .26 to .75; P =.001). There was a nonsignificant trend for fewer serious events (death, resuscitation from ventricular tachycardia/fibrillation, nonfatal myocardial infarction, or hospitalization for unstable angina) in atenolol-treated patients (relative risk, .55; 95% confidence intervals, .22 to 1.33; P =.175). The most powerful univariate and multivariate correlate of event-free survival was absence of ischemia on ambulatory monitoring at 4 weeks. Side effects were mild and generally similar comparing atenolol- and placebo-treated patients, although bradycardia was more frequent with atenolol. CONCLUSIONS: Atenolol treatment reduced daily life ischemia and was associated with reduced risk for adverse outcome in asymptomatic and mildly symptomatic patients compared with placebo.
Mesh-terms: Activities of Daily Living; Atenolol :: therapeutic use; Comparative Study; Double-Blind Method; Electrocardiography, Ambulatory; Female; Follow-Up Studies; Human; Logistic Models; Male; Middle Aged; Myocardial Ischemia :: diagnosis; Myocardial Ischemia :: drug therapy; Myocardial Ischemia :: epidemiology; Prospective Studies; Risk Factors; Support, Non-U.S. Gov't; Time Factors; Treatment Outcome;
Henry R Black,
William J Elliott,
Gregory Grandits,
Patricia Grambsch,
Tracy Lucente,
William B White,
James D Neaton,
Richard H Grimm Jr,
Lennart Hansson,
Yves Lacourciere,
James Muller,
Peter Sleight,
Michael A Weber,
Gordon Williams,
Janet Wittes,
Alberto Zanchetti,
Robert J Anders
University of Florida College of Medicine, Gainesville, Florida, USA.
CONTEXT: Hypertensive patients are often given a calcium antagonist to reduce cardiovascular disease risk, but the benefit compared with other drug classes is controversial. OBJECTIVE: To determine whether initial therapy with controlled-onset extended-release (COER) verapamil is equivalent to a physician's choice of atenolol or hydrochlorothiazide in preventing cardiovascular disease. DESIGN, SETTING, AND PARTICIPANTS: Double-blind, randomized clinical trial conducted at 661 centers in 15 countries. A total of 16 602 participants diagnosed as having hypertension and who had 1 or more additional risk factors for cardiovascular disease were enrolled between September 1996 and December 1998 and followed up until December 31, 2000. After a mean of 3 years of follow-up, the sponsor closed the study before unblinding the results. INTERVENTION: Initially, 8241 participants received 180 mg of COER verapamil and 8361 received either 50 mg of atenolol or 12.5 mg of hydrochlorothiazide. Other drugs (eg, diuretic, beta-blocker, or an angiotensin-converting enzyme inhibitor) could be added in specified sequence if needed. MAIN OUTCOME MEASURES: First occurrence of stroke, myocardial infarction, or cardiovascular disease-related death. RESULTS: Systolic and diastolic blood pressure were reduced by 13.6 mm Hg and 7.8 mm Hg for participants assigned to the COER verapamil group and by 13.5 and 7.1 mm Hg for partcipants assigned to the atenolol or hydrochlorothiazide group. There were 364 primary cardiovascular disease-related events that occurred in the COER verapamil group vs 365 in atenolol or hydrochlorothiazide group (hazard ratio [HR], 1.02; 95% confidence interval [CI], .88-1.18; P =.77). For fatal or nonfatal stroke, the HR was 1.15 (95% CI, .90-1.48); for fatal or nonfatal myocardial infarction, .82 (95% CI, .65-1.03); and for cardiovascular disease-related death, 1.09 (95% CI, .87-1.37). The HR was 1.05 (95% CI, .95-1.16) for any prespecified cardiovascular disease-related event and 1.08 (95% CI, .93-1.26) for all-cause mortality. Nonstroke hemorrhage was more common with participants in the COER-verapamil group (n = 118) compared with the atenolol or hydrochlorothiazide group (n = 79)(HR, 1.54 [95% CI, 1.16-2.04]; P =.003). More cardiovascular disease-related events occurred between 6 AM and noon in both the COER verapamil (99/277) and atenolol or hydrochlorothiazide (88/274) groups; HR, 1.15 (95% CI, .86-1.53). CONCLUSIONS: The CONVINCE trial did not demonstrate equivalence of a COER verapamil-based antihypertensive regimen compared with a regimen beginning with a diuretic or beta-blocker. When considered in the context of other trials of calcium antagonists, these data indicate that the effectiveness of calcium-channel therapy in reducing cardiovascular disease is similar but not better than diuretic or beta-blocker treatment.
Mesh-terms: Adrenergic beta-Antagonists :: therapeutic use; Aged; Antihypertensive Agents :: therapeutic use; Atenolol :: therapeutic use; Calcium Channel Blockers :: therapeutic use; Cardiovascular Diseases :: mortality; Cardiovascular Diseases :: prevention & control; Cerebrovascular Accident :: mortality; Cerebrovascular Accident :: prevention & control; Comparative Study; Delayed-Action Preparations; Diabetes Mellitus; Diuretics, Thiazide :: therapeutic use; Double-Blind Method; Female; Human; Hydrochlorothiazide :: therapeutic use; Hypertension :: drug therapy; Male; Middle Aged; Myocardial Infarction :: mortality; Myocardial Infarction :: prevention & control; Risk Factors; Smoking; Support, Non-U.S. Gov't; Survival Analysis; Vasodilator Agents :: therapeutic use; Verapamil :: therapeutic use;
Left ventricular mass sometimes decreases during treatment of hypertension, but this response is inconsistent and its effects on left ventricular function are unknown. In a six-month randomized trial, we studied the ability of verapamil and atenolol to reduce left ventricular mass in 42 elderly patients with hypertension and the effects of this reduction in mass on cardiac function. The mean blood pressure (+/- SE) decreased in both the group that received verapamil (from 171.4 +/- 3.2/93. +/- 2.5 mm Hg to 142.9 +/- 2.8/79. +/- 2. mm Hg) and the group that received atenolol (from 179.6 +/- 4.6/98.5 +/- 2.4 mm Hg to 148.1 +/- 3.3/83.4 +/- 1.2 mm Hg), but the atenolol-treated patients more frequently required the addition of chlorthalidone to achieve blood-pressure reduction (P less than .01). Verapamil resulted in a reduction in the left-ventricular-mass index from 104 +/- 5 g per square meter of body-surface area to 85 +/- 5 g per square meter (P less than .01). Atenolol did not produce a reduction in the left-ventricular-mass index (109 +/- 9 g per square meter before treatment vs. 112 +/- 10 g per square meter after treatment). Two weeks after the withdrawal of antihypertensive therapy, blood pressure returned to pretreatment values. Nevertheless, in patients whose left ventricular mass had decreased, two measures of diastolic filling, the peak diastolic filling rate to the peak ejection rate, were significantly higher than before treatment (2.42 +/- .2 vs. 3.31 +/- .4 [P less than .05] and .61 +/- .03 to .85 +/- .05 [P less than .05], respectively). Diastolic filling was unchanged in the group that had no reduction in left ventricular mass. Cardiac output and the ejection fraction at rest and during mild exercise were unchanged in both groups as compared with baseline values. We conclude that left ventricular mass can be reduced in elderly patients with hypertension and mild ventricular hypertrophy who receive antihypertensive therapy. Reduction occurs more frequently with verapamil than with atenolol therapy, increases diastolic filling, and does not impair systolic function.
Mesh-terms: Atenolol :: therapeutic use; Blood Pressure; Cardiomegaly :: diagnosis; Cardiomegaly :: drug therapy; Double-Blind Method; Echocardiography; Gated Blood-Pool Imaging; Hemodynamic Processes; Human; Hypertension :: drug therapy; Hypertension :: physiopathology; Middle Aged; Randomized Controlled Trials; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S. ; Verapamil :: therapeutic use;
Department of Geriatrics and Metabolic Diseases, Second University of Naples, Italy.
BACKGROUND: Diabetic patients are considered less suitable than nondiabetic patients for beta-blocker therapy because of the risk for worsened glucose and lipid metabolism and more severe hypoglycemic attacks. OBJECTIVE: To compare the metabolic and cardiovascular effects of carvedilol with those of atenolol in diabetic patients with hypertension. DESIGN: Randomized, double-blind, 24-week trial. SETTING: University hospital clinic. PATIENTS: 45 patients with non-insulin-dependent diabetes mellitus and hypertension. INTERVENTION: After a 4- to 6-week run-in period during which placebo was given in a single-blind manner, patients were randomly assigned to carvedilol or atenolol. MEASUREMENTS: An oral glucose tolerance test; assessment of insulin sensitivity and hormonal responses to insulin hypoglycemia; and assessment of lipid levels, blood pressure, left ventricular mass, and lipid peroxidation. RESULTS: Changes in systolic and diastolic blood pressure and left ventricular mass index were similar with carvedilol and atenolol (P > .2). Fasting plasma glucose and insulin levels decreased with carvedilol and increased with atenolol. Responses to carvedilol were greater than those to atenolol, as follows: increase in total glucose disposal, 9.54 mumol/kg of body weight per minute (95% CI, 7 to 11.9 mumol/kg per minute); decrease in plasma glucose response to oral glucose, 61 mmol/L x 180 minutes (CI,-101 to -21 mmol/L x 180 minutes); decrease in insulin response to oral glucose, 6.2 nmol/L x 180 minutes (CI,-9.8 to -2.6 nmol/L x 180 minutes); decrease in triglyceride level, .56 mmol/L (CI,- .75 to - .37 mmol/L; P < .001); increase in high-density lipoprotein cholesterol level, .13 mmol/L (CI, .09 to .17 mmol/L; P < .001); and decrease in lipid peroxidation, .25 mumol/L (CI,- .34 to - .16 mumol/L). CONCLUSIONS: By improving glucose and lipid metabolism and reducing lipid peroxidation, carvedilol may offer advantages in patients with diabetes and hypertension.
Mesh-terms: Adrenergic alpha-Antagonists :: therapeutic use; Adrenergic beta-Antagonists :: therapeutic use; Antihypertensive Agents :: therapeutic use; Atenolol :: therapeutic use; Blood Glucose :: metabolism; Carbazoles :: therapeutic use; Diabetes Mellitus, Type II :: blood; Diabetes Mellitus, Type II :: complications; Diabetic Angiopathies :: blood; Diabetic Angiopathies :: drug therapy; Double-Blind Method; Female; Human; Hypertension :: blood; Hypertension :: complications; Hypertension :: drug therapy; Lipid Peroxidation :: drug effects; Lipids :: blood; Male; Middle Aged; Propanolamines :: therapeutic use; Single-Blind Method;
E Saunders,
M R Weir,
B W Kong,
J Hollifield,
J Gray,
V Vertes,
J R Sowers,
M B Zemel,
C Curry,
J Schoenberger
Department of Medicine, University of Maryland Hospital, Baltimore.
A double-blind, positively controlled, forced dose titration study comparing the efficacy and safety of atenolol, captopril, and verapamil sustained release as single agents in the treatment of black patients with mild to moderate hypertension (diastolic blood pressure, 95 to 114 mm Hg) was conducted. A total of 394 patients were randomized to one of the three therapies. Mean blood pressures during a 2- to 4-week placebo treatment period (baseline) ranged from 100.4 to 100.7 mm Hg diastolic and 151.7 to 152.5 mm Hg systolic for the three groups. Of the patients, 355 (of whom 345 had assessable data) completed the first treatment period, which consisted of therapy with either 50 mg/d of atenolol, 25 mg every 12 hours of captopril, or 240 mg/d of verapamil sustained release. During the second 4-week treatment period, which 319 patients completed (307 assessable), half of the patients had their antihypertensive medication increased and the other half continued the same dose. Goal blood pressure was defined as a supine diastolic pressure of less than 90 mm Hg or a 10-mm Hg or greater drop in supine diastolic blood pressure from pretreatment levels. Atenolol, captopril, and verapamil sustained release therapy was associated with goal blood pressure achievement during the first treatment period 55.1%, 43.8%, and 65.2% of the time, respectively, and during the second treatment period 59.6%, 57.1%, and 73. % of the time. Side effects were minimal and comparable for all three drugs.
Mesh-terms: Adult; African Continental Ancestry Group; Aged; Atenolol :: adverse effects; Atenolol :: therapeutic use; Captopril :: adverse effects; Captopril :: therapeutic use; Comparative Study; Delayed-Action Preparations; Dose-Response Relationship, Drug; Double-Blind Method; Female; Heart Rate :: drug effects; Human; Hypertension :: drug therapy; Hypertension :: ethnology; Male; Middle Aged; Multicenter Studies; Randomized Controlled Trials; Renin :: blood; Supination; Support, Non-U.S. Gov't; Verapamil :: adverse effects; Verapamil :: therapeutic use;
