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Atenolol and three nonselective beta-blockers in hypertension
Insights
Cardioselective atenolol showed potential advantages over noncardioselective beta-blockers in hypertension treatment. Atenolol lowered diastolic blood pressure and serum creatinine, with no significant impact on lung function or glucose tolerance.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Hypertension management often involves beta-blockers.
- Cardioselective beta-blockers offer targeted action, potentially reducing side effects compared to noncardioselective agents.
Purpose of the Study:
- To compare the efficacy and safety of cardioselective atenolol versus noncardioselective beta-blockade in treating hypertension.
- To evaluate effects on blood pressure, heart rate, and various biochemical markers.
Main Methods:
- A crossover trial involving 27 hypertensive patients previously controlled on nonselective beta-blockers.
- Patients were randomized to receive either atenolol or their previous nonselective beta-blocker for 8 weeks.
- Evaluations included blood pressure, pulse rate, spirometry, glucose tolerance, lipid profiles, and stress tests.
Main Results:
- Atenolol, at equivalent systolic blood pressure lowering doses, resulted in lower diastolic blood pressure at rest and during stress.
- Serum creatinine levels were lower with atenolol compared to noncardioselective beta-blockers.
- No significant differences were observed in lung function or glucose/insulin levels, even in diabetic patients.
Conclusions:
- Cardioselective atenolol may offer benefits in hypertension management, including improved diastolic blood pressure control and reduced serum creatinine.
- Atenolol demonstrated a favorable profile regarding metabolic and respiratory parameters in this patient cohort.
Abstract:
The object of this study was to establish whether cardioselectivity of atenolol confers any advantage over noncardioselective beta-blockade in the treatment of hypertension. A dose of atenolol was established on the basis of morning mean systolic blood pressure (mean of 5 readings) in 27 long-standing hypertensive patients previously controlled on one of three nonselective beta-blockers: propranolol, oxprenolol, or pindolol. Most patients were also taking a diuretic. A crossover trial was then conducted of atenolol and the previous nonselective beta-blocker, each drug being given for 8 wk in randomized order. Other drugs were kept constant. At the end of each 8-wk period a morning test of blood pressure and pulse rate was done, an 11:30 A.M. blood sample was taken for estimation of drug concentration, and spirometry was performed. During the eighth week a glucose tolerance test, fasting lipids, and other biochemical and hematologic estimations were done. On a separate occasion a late morning study was done on the response of blood pressure and pulse rate to three kinds of stress: bicycle ergometer, mental arithmetic, and handgrip. At dosage levels of atenolol giving a mean resting systolic blood pressure equal to that during nonselective beta-blockade, diastolic levels on atenolol tended to be lower at rest and during the mental and handgrip forms of stress. Serum creatinine levels on atenolol were lower than during nonselective beta-blockade. Anti-dioxyribonucleic acid (DNA) titers remained normal in all patients. There was no difference in lung function. There was little difference in glucose and insulin levels during glucose tolerance tests in these patients, half of whom were diabetic. There were no serious side effects but there were a few surprising ones such as vivid dreams in three and muscle cramps in one patient.