Atenolol as initial antihypertensive therapy: an observational study comparing first-line agents

Area of Science:

• Cardiology
• Pharmacology
• Public Health

Background:

• Atenolol's role in hypertension management is debated.
• Recent clinical trials necessitate real-world evaluation.

Purpose of the Study:

• To assess the real-world cardiovascular outcomes associated with atenolol compared to other first-line antihypertensives.
• To validate recent clinical trial findings in a broader patient population.

Main Methods:

• Retrospective cohort study utilizing linked administrative data.
• Inclusion of first-time users of antihypertensives (1994-2003).
• Comparison of atenolol, ACE inhibitors, thiazide diuretics, and calcium antagonists during monotherapy.

Main Results:

• 19,249 patients were analyzed with a mean follow-up of 2.3 years.
• Similar rates of myocardial infarction, unstable angina, stroke, or death across all treatment groups.
• Adjusted analyses showed no increased risk with atenolol compared to other agents (HRs 1.03-1.24).

Conclusions:

• Atenolol monotherapy for uncomplicated hypertension is not associated with increased cardiovascular morbidity or mortality.
• Low event rates observed across all first-line antihypertensive classes.
• Further research is recommended to identify specific patient subgroups who may need to avoid atenolol.