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Old 02-27-2010, 08:50 AM   #16
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Re: Reducing heart rate with beta blockers in hypertension is it harmful or Atenolol?

Ace, I don't know if I want to see 100!

Over the past couple of decades (since age 50), I've had to avoid all kinds of things that negatively effect either my Blood Pressure, Heart Rhythm, Energy and/or Breathing.

I have a relatively good quality of life, but I live in this pseudo bubble where I am very much limited. As long as I still have a good quality of life, and my health continues to get progressively better, I would love to live as long as I can. But..... at the same time, the thought of living in this pseudo bubble for another 30 years does not please me.

So..... I thank you for your suggestion, but I think that I will focus on the 80 mark instead of the 100 mark!

I noticed that you were on Bystolic. How well does that work for you?

If you don't mind me asking, what motivated you to post about Atenolol? Are you thinking of switching to a different Beta Blocker? Atenolol and Carvedilol are a lot cheaper than Bystolic, since both are genetically available.
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Last edited by Machaon; 02-27-2010 at 08:52 AM.

 
Old 02-27-2010, 05:42 PM   #17
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Re: Reducing heart rate with beta blockers in hypertension is it harmful or Atenolol?

Machaon - I guess the reality is, we should take it one day at a time. Let's hope for the best at any age. Ghandi had a saying which goes something like this: "Live each day as if it were your last, Keep learning as if we will live forever". Bystolic is working pretty well for me. In the beginning the side effects such as poor sleep, which leads to fatigue, became torublesome. After a few months the side effects lifted. Blood pressure is pretty much controlled, and anxiety symptoms have improved. It's true some beta blockers have a better effect on anxiety and nervous symptoms, but they also have more side effects. The main concern I have with Bystolic is that it's a newer pill (newer is not always better) and Bystolic has a tendency to increase Blood Glucose levels and Cholesterol values. It also decreases HDL as many other beta blockers do. How relevant these small increases are, is still debatable. These negative effects are exactly the same reason why doctors question Atenolol. The benefits of Bysolic versus Atenolol is the improvement in Blood Vessel Function, lowering of blood CRP levels and stronger benefits in Cardiac Function. Are these benefits more beneficial in the long run? I guess to a large degree, the jury is still out.

 
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Old 02-28-2010, 09:30 AM   #18
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Re: Reducing heart rate with beta blockers in hypertension is it harmful or Atenolol?

Quote:
Originally Posted by ACE28 View Post
I'm not trying to be an advocate for Atenolol, but which drug really is effective for preventing Cardiovascular issues? The articles use Atenolol to bash all beta-blockers, and it's really not fair. when compared to Ace Inhibitors. Does this apply to all ARB'S??? Who knows.... Is it safer than Atenolol??
The fact is when used to treat hypertension atenolol has never been shown to reduce mortality ; heart attacks or stokes. You would be hard pressed to find a hypertension expert that would argue with that . The range of debate on this is best shown by two fairly resent articles in the one "Beta-Blockers in Hypertension. Adding Insult to Injury*. Norman M. Kaplan, MD*. University of Texas Southwestern Medical Center, Hypertension Division" JACC 2008 "Atenolol is dead ; long live beta -blockade JACC 2009" which notes that when it is used to treat hypertension it is to early to remove all beta blockers '..it is high time to stop prescribing atenolol"
While it may not be fair to use atenolol to bash all beta blocker it is interesting that the least effective beta blocker is the most widely RX'd
Why doesn't it work if you look at the cafe study atenolol does not reduce central blood pressure , antenolol increases the risk of diabetes , it lowers HDL ect .ect .ect.
Since the data shows that atenolol is the least effective hypertensive drug and the most side effect prone and there and interesting study LIFE which shows an arb superior to atenolol, The risk benefit of this drug does not appear to be acceptable.

 
Old 03-01-2010, 06:53 AM   #19
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Re: Reducing heart rate with beta blockers in hypertension is it harmful or Atenolol?

In the Nordic Diltiazem trial, comparing Calcium blockers to Beta blockers,
The rate of the prespecified composite endpoint of stroke, myocardial infarction, or vascular death was no different between the groups; the risk of stroke was (barely) significantly less in the diltiazem group. For Calcium Blockers in general, Although the evidence seems to support the use of calcium blockers for the prevention of stroke compared with placebo, there have been concerns that these agents when used as first-line treatment may increase the risk of cardiac endpoints relative to other antihypertensives.
In one large meta-analysis of over 27,000 patients studied in prospective, randomized trials of long-acting calcium blockers as opposed to beta blockers (mainly Atenolol), ACE inhibitors or diuretics, those randomized to calcium blockers had a substantially greater risk of congestive heart failure or myocardial infarction without benefits in terms of stroke or all-cause mortality.
In the "Captopril Prevention Project" a trial of more than 10,00 patients,
When Ace Inhibitors (Captopril) was compared to a beta blocker (mainly Atenolol/Metoprolol) and examined for a variety of vascular endpoints. In this study, there were no significant differences, with the exception of a slightly higher risk of stroke in the captopril group. Captopril increased the stroke risk.

P.S. Which HBP blood pressure drug is really better to take???? When many very popular classes of drugs are failing when compared to Atenolol (supposedly the worst beta blocker), What does that say for the other types of HBP drug classes? Worse yet, doctors are eager to switch us all from Atenolol. Unfortunately, Many HBP drugs when researched in trials are failing miserably when compared to Atenolol or examined closely.

Last edited by hb-mod; 03-01-2010 at 07:03 AM. Reason: Removed Quote of immediately preceding post. Please use "Quick" Reply rather than "Quote" Reply. Thanks!

 
Old 03-01-2010, 04:04 PM   #20
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Re: Reducing heart rate with beta blockers in hypertension is it harmful or Atenolol?

I agree that all these trials comparing the hypertension drugs with each other are necessary and helpful; however, I still believe that each person is different and needs different drugs. I wish each doctor who is treating a hypertensive patient had the time to send the results along with the medical problems of the patient to the drug companies (or the FDA). Many of us have
several, and different, reasons for needing hypertension drugs. Each doctor has to decide which combination of hypertensive drugs to prescribe for his patient. different combinations work for each patient most times - plus the addition of the other drugs he/she is taking. Many of these trials are conducted with some of the funding coming from the drug company which manufactures the particular drug. Each person reacts differently to his/her drug or combination of drugs, IMHO. Atenolol may work fine for one patient but cause the next patient to have a heart attack, etc. One example is the renin inhibitor drug, Tekturna. It supposedly was a miracle drug; but I can find only a few good reviews for this drug - most of the opinions I read were very negative - as was mine. It made my blood pressure rise!
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Old 03-01-2010, 05:40 PM   #21
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Re: Reducing heart rate with beta blockers in hypertension is it harmful or Atenolol?

I think you are referring to this trail... " Randomised trial of effects of calcium antagonists compared with diuretics and beta-blockers on cardiovascular morbidity and mortality in hypertension: the Nordic Diltiazem (NORDIL) study." published in the Lancet which was not a direct comparison of CCBs to atenolol but to the atenolol diuretic combination even so there where more stokes in the atenolol arm. I would note this is not a direct comparison trail.

There are some better comparison trails in the LIFE trail atenolol was compared to Losartan. Losartan the clear winner. I do not believe there is a study where atenolol out performs the comparison drug .

Last edited by hb-mod; 03-02-2010 at 06:50 AM. Reason: Removed Quote. Please use "Quick" Reply rather than "Quote" Reply. Thanks!

 
Old 03-02-2010, 06:11 AM   #22
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Re: Reducing heart rate with beta blockers in hypertension is it harmful or Atenolol?

Atenolol has the biggest market share of any hypertensive drug in most parts of the world, this is the reason why numerous trials compare their drug to Atenolol. Keep in mind, that many drug trials have done very poorly when compared to Atenolol, In these cases, the poor trial results were never published for release. Only the negative Atenolol trials are being given extra attention and shedding a negative light on Atenolol.This is similar to the Vitamin E controversy, Many studies have proven the benefit of Vitamin E on Inflammation, heart disease, powerful antioxidant capabilities, and the positive effects on brain function. The latest Vitamin E publications, reported by some of the largest medical journals, took several trials and stated that Vitamin E is useless, does not have heart healing effects, and increases the risk of death. Vitamin A according to the latest research increases the lung cancer risk. Which is true??

 
Old 03-02-2010, 06:32 AM   #23
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Re: Reducing heart rate with beta blockers in hypertension is it harmful or Atenolol?

In the Diltiazem trial - Their was no difference in this comparison study, though the major concerns have been that Calcium blockers may increase the risk of cardiac endpoints.

To repeat the Diltiazem trial conclusions:
The rate of the prespecified composite endpoint of stroke, myocardial infarction, or vascular death was no different between the groups; the risk of stroke was (barely) significantly less in the diltiazem group. For Calcium Blockers in general, Although the evidence seems to support the use of calcium blockers for the prevention of stroke compared with placebo, there have been concerns that these agents when used as first-line treatment may increase the risk of cardiac endpoints relative to other antihypertensives.

The largest beta blocker trial called MERIT - Toprol-XL patients
had a 34% risk reduction for all-cause mortality.
Heart-related mortality was reduced 38%, sudden death by
41%, and heart failure death by 49%. The drug reduced
mortality in patients regardless of heart class.


Note: If any hypertension drug currently available, were to compare to beta blockers, such as Toprol or Coreg, on all end-points, they would fail miserably. Companies are too smart to take that chance. This is the reason Atenolol has become the comparative drug, and even so, many drugs have failed versus Atenolol, (Trials not published) All other beta blockers have been found guilty by association.

Last edited by hb-mod; 03-02-2010 at 06:48 AM. Reason: Removed Quote. Please use "Quick" Reply rather than "Quote" Reply. Thanks!

 
Old 03-02-2010, 08:56 AM   #24
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Re: Reducing heart rate with beta blockers in hypertension is it harmful or Atenolol?

The header notes that atenolol is not very useful in hypertension The trail you cite MERIT uses both a different beta -blocker and a different class of patients people with heart failure . beta blockers are use full in this regard Unpublished trails either are negative trails or have been conducted so poorly that they could not be published. The fact is that the data shows atenolol to be a very ineffective drug when used in hypertensive patients.; most would say the evidence is better for other classes of drug.

 
Old 03-02-2010, 07:45 PM   #25
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Re: Reducing heart rate with beta blockers in hypertension is it harmful or Atenolol?

The evidence is very poor with most classes of drugs. Only Ace Inhibitors (particularly, Perindopril and Ramipril) have conducted very large studies and have been remarkably effective for hypertension, heart disease and kidney disease. All other classes have raised serious concern. ARB's have fallen short in regard to MI's, Alpha Blockers have fallen by the wayside, and Calcium blockers have always raised controversy regarding end points. Diuretics have been touted by many trials as being the most effective and safest for long term use. The problem I had in the past with Ace Inhibitors, was a nagging cough and tickle in my throat.

 
Old 03-03-2010, 09:14 AM   #26
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Re: Reducing heart rate with beta blockers in hypertension is it harmful or Atenolol?

In my opinion most unbiased analysis comes from the Cochrane data base they basically look at all the studies and simply sort the data . They concluded beta blockers are the least effective class of drug . They note that atenolol is primarily responsible for the fact that beta blockers perform so poorly. The only other comment is the evidence of diuretics being superior comes largely from the ALLHAT trail which many would argue was seriously flawed.

 
Old 03-03-2010, 09:48 AM   #27
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Re: Reducing heart rate with beta blockers in hypertension is it harmful or Atenolol?

Quote:
Originally Posted by bigvince1 View Post
In my opinion most unbiased analysis comes from the Cochrane data base they basically look at all the studies and simply sort the data . They concluded beta blockers are the least effective class of drug . They note that atenolol is primarily responsible for the fact that beta blockers perform so poorly. The only other comment is the evidence of diuretics being superior comes largely from the ALLHAT trail which many would argue was seriously flawed.
ALLHAT was a huge blow to the hypertensive drug market. When diuretics (one of the oldest and cheapest hypertension medications available), outperformed almost every class of newer and expensive hypertensive drugs, this came as a huge shock and embarassment to the large name Drug companies. Of course the drug companies will argue that the results were seriously flawed. This study was unbiased and one of the largest hypertensive medication study ever conducted for over 4 years. This trial was Supported by the National Heart, Lung, and Blood Institute. Keep in mind this study could use either a diuretic or a beta blocker, which were considered the older and proven drugs. They chose a diuretic for the study's traditional (standard control) arm, a diuretic (chlorthalidone) was selected over a beta-blocker because diuretics had been studied more extensively. In addition, although evidence from several randomized trials found comparable CVD outcomes when initial treatment with diuretic was compared to beta-blocker, diuretics were considered clinically advantageous for the types of patients to be selected for ALLHAT, older patients and those at higher risk of CVD complications. The conclusions of this trial were, that the older medications, diuretics were far superior to every other class of medications.
ALLHAT demonstrated that chlorthalidone is superior at preventing CVD events compared to each of the treatment drugs studied: calcium channel blocker (amlodipine), ACE inhibitor (lisinopril), and alpha-adrenergic blocker (doxazosin). Each of the newer drugs had significantly higher rates of one or more forms of cardiovascular disease, and lisinopril and doxazosin had higher rates of combined CVD. None of the three test treatments differed significantly from chlorthalidone in rates of major coronary heart disease (CHD) events and all-cause mortality. This "unbiased study" favors the older
drugs, diuretics and beta blockers as a continued 1'st choice with end points to prove it.

 
Old 03-04-2010, 08:32 AM   #28
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Re: Reducing heart rate with beta blockers in hypertension is it harmful or Atenolol?

The complaint that ALLHAT was severely biased has been stated by many hypertension experts one in fact called it "garbage" why? First lets look at the study which was slightly different than you stated . Patients where randomised to receive either a diuretic ; ccb or ACE inhibitor. Beta blockers where not a first line choice. If blood pressure control was not achieved with 1 drug a second was given alpha-adrenergic blocker where not a first choice and where rarely used in this study. Why where beta blockers not a first line choice in the study ? Because by that time they where regarded as inferior and the feeling was they should not be first line drugs. However many in the study received Atenolol as second line therapy. The study did indeed find that diuretics whereat least equal to ACE inhibitors and CCBS the other first line drugs involved. Why was the study biased: by design the study put the ACE inhibitor at a disadvantage . How to explain. that .It is commonly accepted that people are hypertensive because of either high renin or high volume several drugs effect high renin ARBS ,ace inhibitors ,beta blockers for high volume diuretics and CCBS are effective. In this trail because the backup drug was atenolol ACE inhibitors where at a disadvantage . The bottom line is this if you have primarily high renin hypertension ACE inhibitors or ARBS will be most effective if you have high volume hypertension diuretics and calcium channel blockers will be the most effective most people have some of both hence fixed drug combinations are often RX'd. Beta blockers largely because of atenolol are the only group that are viewed as inferior. In the UK guidelines are set and followed the guidelines recommend that bea blocker are no better that the fouth drug used in hypertension. Two recent studies of interest. One in circulation found that selective beta blockers may help remodel the heart in a positive manor unfortunately non selective beta blockers caused negative remodeling . Another found that LVH was reduced more with ARB therapy than other therapy. The authors noted that the superiority of arbs was less convincing {copaded to ace and diuretics] while the inferiority of bet blockers was apparent.

 
Old 03-04-2010, 11:41 AM   #29
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Re: Reducing heart rate with beta blockers in hypertension is it harmful or Atenolol?

The best choice will always be the most proven drug in it's class. Medication's such as Metoprolol, Coreg, Bisoprolol, Cozaar, Altace, Aceon come to mind.

 
Old 03-07-2010, 05:26 AM   #30
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Re: Reducing heart rate with beta blockers in hypertension is it harmful or Atenolol?

Interesting that your list includes 3 beta blockers which have been shown in many studies to be less effective in hypertension than any other drug class. The only drug on your list shown to be superior was losartan which was proven in the life study superior to atenolol.

 
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