It appears you have not yet Signed Up with our community. To Sign Up for free, please click here....



High & Low Blood Pressure Message Board
Post New Thread   Closed Thread
LinkBack Thread Tools
Old 03-08-2010, 09:51 AM   #31
Senior Veteran
(male)
 
Join Date: Apr 2005
Location: N.Y
Posts: 705
ACE28 HB UserACE28 HB UserACE28 HB UserACE28 HB User
Re: Reducing heart rate with beta blockers in hypertension is it harmful or Atenolol?

None of the drugs mentioned increased the heart attack risk like most calcium blockers, alpha blockers and ARB's. The beta blockers I mentioned decrease the risk of sudden death, MI and particularly morning heart attacks, when adrenalin is at it's highest. They are the safest bets at this time. The 3'rd generation beta blockers such as Nebivolol and Carevedilol which also have Vasodilation mechanisms, appear to target endothelial dysfunction, increase blood flow to the heart and improve quality of life. The gold standard used by the best Cardiologist's is still Toprol XL for hypertension, heart failure, Previous MI and arrythmia. Many others don't appear to suffice.

Last edited by ACE28; 03-08-2010 at 09:53 AM.

 
Old 03-09-2010, 07:22 AM   #32
Junior Member
(male)
 
Join Date: Feb 2010
Posts: 15
bigvince1 HB User
Re: Reducing heart rate with beta blockers in hypertension is it harmful or Atenolol?

Unsupported a statements simply are not facts calling any drug the 'Gold standard" used by " the best 'Cardiologist " Something out of advertising no facts just assertions. Some fact... several studies have found beta blockers inferior in the treatment of hypertension. When compared to CCB; diuretics; ACE or arbs. To show in pratice what the 'best' hypertension specialist say one just needs to look at the NICE guidelines in the UK guidelines written by 'the best' where beta blockers are not recommended as first ,second or third line therapy.

 
Sponsors Lightbulb
   
Old 03-09-2010, 08:48 AM   #33
Veteran
(female)
 
Join Date: Sep 2005
Location: Connecticut
Posts: 376
mabent HB Usermabent HB Usermabent HB Usermabent HB User
Re: Reducing heart rate with beta blockers in hypertension is it harmful or Atenolol?

I have decided never to look at drug-comparison "Studies" again after reading your post(s). Since I have started taking carvedilol(beta blocker), my blood pressure readings have changed from 160/90 and up to 120/70 and 130/80. I also take a diuretic (HCTZ), an ace inhibitor (enalapril), and a calcium channel blocker (amlodipine). It took a month for my pressure to reach these levels. Also, I am not tired any longer and in general feel much better. I think that more testing should be done on the newer drugs (example: Tekturna!) Mabent

 
Old 03-09-2010, 08:59 AM   #34
Senior Veteran
(male)
 
Join Date: Apr 2005
Location: N.Y
Posts: 705
ACE28 HB UserACE28 HB UserACE28 HB UserACE28 HB User
Re: Reducing heart rate with beta blockers in hypertension is it harmful or Atenolol?

Keep in Mind, Pharmaceutical corporation influence exist in the UK also. The beta blocker Nebivolol was denied Heart failure approval in the U.S. last month. The U.K approved this indication without any questions. Yet, the U.S. FDA found numerous irregularities in their reporting methods, and the Mortality results were far from robust in comparison to the proven beta blockers. I mention Gold standard because my cardiologist classified it as such, and several friends and relatives had Surgical Bypass proceedures or stents performed at either N.Y Cornell Medical Center or N.Y Columbia Presbyterian Medical Center, in recent years, by some of the best Cardio-specialists (possibly in the world), When I inquire about their daily medication regimen, it almost always includes Toprol XL and sometimes Enalapril combinations. They are most often switched to these medications, regardless of their previous hypertensive medications. Why?? Because they have proven effective and FDA guidelines have approved these medications (only). It's unethical to prescribe anything which is not effective or approved. Even several negative beta blocker studies, are better than no studies at all, which is the case for most HBP medications. These studies need to be put into proper perspective.

 
Old 03-11-2010, 11:40 AM   #35
Junior Member
(male)
 
Join Date: Feb 2010
Posts: 15
bigvince1 HB User
Re: Reducing heart rate with beta blockers in hypertension is it harmful or Atenolol?

You have a tendency to mix studies in people post MI or with Heart failure with studies of people with hypertension. Beta blockers and reduced heart rate have shown to extend life and prevent events in people with these conditions a recent study paradoxically found that reducing heart rate in people with hypertension had the opposite effect ..

" Relation of Beta-Blocker–Induced Heart Rate Lowering and Cardioprotection in Hypertension' J Am Coll Cardiol, 2008; 52:1482-1489,

.......Results: Of 22 randomized controlled trials evaluating beta-blockers for hypertension, 9 studies reported heart rate data. The 9 studies evaluated 34,096 patients taking beta-blockers against 30,139 patients taking other antihypertensive agents and 3,987 patients receiving placebo. Paradoxically, a lower heart rate (as attained in the beta-blocker group at study end) was associated with a greater risk for the end points of all-cause mortality (r = –0.51; p < 0.0001), cardiovascular mortality (r = –0.61; p < 0.0001), myocardial infarction (r = –0.85; p < 0.0001), stroke (r = –0.20; p = 0.06), or heart failure (r = –0.64; p < 0.0001). The same was true when the heart rate difference between the 2 treatment modalities at the end of the study was compared with the relative risk reduction for cardiovascular events.

Conclusions: In contrast to patients with myocardial infarction and heart failure, beta-blocker–associated reduction in heart rate increased the risk of cardiovascular events and death for hypertensive patients...'

Pretty straightforward but because this study looked at studies using primarily atenolol the real question is is it the heart rate that's causing the bad effect or the atenolol.

Previous studies had concluded that beta blockers in general where less effective than other drugs again because most of the studies used atenolol.

Now the experts in this field are looking at why atenolol performs so poorly newer beta blockers have different characteristics. The results from atenolol may not be representetive of newer beta blockers.

Interestingly atenolol reduces central pressure less than other hypertensive drugs a fairly recent study J Hypertens. 2008 Feb;26
"A comparison of atenolol and nebivolol in isolated systolic hypertension."

"Some beta-blockers are less effective in reducing central blood pressure than other antihypertensive drugs, which may explain the higher rate of events in subjects randomized to atenolol in recent trials ...
.....CONCLUSIONS: Nebivolol and atenolol have similar effects on brachial blood pressure and aortic stiffness. However, nebivolol reduces aortic pulse pressure more than atenolol,"

I think you would be hard pressed to find a hypertension expert that would recommend atenolol for hypertension the debate in that community has moved on. Here a recent editorials.
" John R. Cockcroft. Atenolol Is Dead: Long Live Beta-Blockade .... JACC Vol. 53,
June 2, 2009

"Further, hypertensive patients younger than 50 years old may benefit more from beta-blockade than older patients, as they have a different hemodynamic form of hypertension . However, all evidence to date suggests that a beta-blocker other than atenolol should be chosen when beta-blockade is required.

It is premature to sound the death knell for all beta-blockers in the treatment of hypertension based upon the Bangalore et al. review, but it is high time to stop prescribing atenolol.......

 
Old 03-11-2010, 05:10 PM   #36
Senior Veteran
(male)
 
jonnstar's Avatar
 
Join Date: Mar 2010
Posts: 1,873
jonnstar HB Userjonnstar HB Userjonnstar HB Userjonnstar HB Userjonnstar HB Userjonnstar HB Userjonnstar HB Userjonnstar HB Userjonnstar HB Userjonnstar HB Userjonnstar HB User
Re: Reducing heart rate with beta blockers in hypertension is it harmful or Atenolol?

Why would any doctor prescribe beta blockers as a first choice in hypertension these days, with diuretics and ace inhibitors so cheap, effective and safe?

I am sure beta blockers have a place in the small number of resistant or malignant hypertensives, but for the vast majority, they are dinosaurs

 
Old 03-12-2010, 09:21 AM   #37
Senior Veteran
(male)
 
Join Date: Apr 2005
Location: N.Y
Posts: 705
ACE28 HB UserACE28 HB UserACE28 HB UserACE28 HB User
Re: Reducing heart rate with beta blockers in hypertension is it harmful or Atenolol?

Quote:
Originally Posted by jonnstar View Post
Why would any doctor prescribe beta blockers as a first choice in hypertension these days, with diuretics and ace inhibitors so cheap, effective and safe?

I am sure beta blockers have a place in the small number of resistant or malignant hypertensives, but for the vast majority, they are dinosaurs
Many Reasons, among them is the fact that Ace Inhibitors main side effect is a horrible nagging dry cough which can effect sleep and quality of life. Diuretics, besides causing urinary tract issues and sexual dysfunction, also deplete vital minerals (including potassium) and can cause severe dizziness.

 
Old 03-12-2010, 09:30 AM   #38
Senior Veteran
(male)
 
Join Date: Apr 2005
Location: N.Y
Posts: 705
ACE28 HB UserACE28 HB UserACE28 HB UserACE28 HB User
Re: Reducing heart rate with beta blockers in hypertension is it harmful or Atenolol?

BigVince - Your last paragraph is exactly what the main theme of these threads have been about, Is it harmful or Atenolol? It appears the Atenolol controversies are shedding a negative light on most beta blockers. I think this position does not do justice to the many more proven beta blockers.

 
Old 03-13-2010, 07:59 AM   #39
Junior Member
(male)
 
Join Date: Feb 2010
Posts: 15
bigvince1 HB User
Re: Reducing heart rate with beta blockers in hypertension is it harmful or Atenolol?

My point is larger no real evidence exist that beta blockers are as effective as any other family of drug when used in hypertension atenolol has been shown to be little better than placebo. When summed up in meta analysis beta blockers as a group all are less effective than other classes of drugs. Ace ; ARBs ;diuretics ;CCBs all have better evidence for use in hypertension. All have less adverse effects than atenolol. Beta blockers have been linked with increased diabetes. The question is why push this class of drug for hypertension. Atenolol has in many studies been shown inferior; it is also the most commonly used. Whether other beta blockers are better remains to be seen. ARBs have been shown in a recent study to be the best agents to reduce LVH a target of treatment . The study "Regression of left ventricular mass by antihypertensive treatment: a meta-analysis of randomized comparative studies." published nov. 2009 Hypertension . Compared all the commonly used classes of drug it found ARBs the best and beta blockers the worse commenting the authors noted .

"... beta-blocker treatment was a significant and negative predictor of the regression (-3.6%; P<0.01), but this was not the case for the other drug classes, including angiotensin receptor blockers. In conclusion, beta-blockers show less regression of left ventricular mass, whereas angiotensin receptor blockers may induce larger regression. The inferiority of beta-blockers appears to be more convincing than the superiority of angiotensin receptor blockers."

 
Old 03-13-2010, 11:03 AM   #40
Senior Veteran
(male)
 
Join Date: Apr 2005
Location: N.Y
Posts: 705
ACE28 HB UserACE28 HB UserACE28 HB UserACE28 HB User
Re: Reducing heart rate with beta blockers in hypertension is it harmful or Atenolol?

Verma and Strauss, BMJ 2004;329:1248-1249 have published a study several years ago (This is public information) which found Angiotensin II Blockers to increase MI risk. ARB II's were among the worst. The authors state that this should be made public and known to everyone currently on ARB's. The interpretation of large scale clinical trials is being increasingly scrutinized by leading journals, with great emphasis being placed on the importance of sharing all potential side effects, no matter how trivial, with patients. The Lancet published the results of the valsartan antihypertensive long term use evaluation (VALUE) trial, a study of the effects of reducing blood pressure in patients at high risk. The angiotensin receptor blocker valsartan produced a statistically significant 19% relative increase in the prespecified secondary end point of myocardial infarction (fatal and non-fatal) compared with amlodipine. To fare so miserably with a drug such as amlodipine, (which is no better than placebo) and causes horrible edema, explans it all. Candesartan also failed miserably. Cozaar was only effective for stroke. Yes, this study caused controversy, but the truth should be told according to the authors. The BMJ is still one of the most prestigious medical journals. Only Ace Inhibitors (once again) were found to show clinical benefit
in all end points. I still conclude, that Beta blockers and Ace Inhibitors are the better hypertension medications of the bunch.

 
Old 03-13-2010, 12:28 PM   #41
Junior Member
(male)
 
Join Date: Feb 2010
Posts: 15
bigvince1 HB User
Re: Reducing heart rate with beta blockers in hypertension is it harmful or Atenolol?

Atenolol and beta blockers have been shown to be inferior to all other hypertensive treatments. The editorial you cite Verma published in the BMJ isten years old and has been widely critiqued :and a later more complete study in the same journal ..."Angiotensin receptor blockers and risk of myocardial infarction: systematic review " BMJ 2005. Michael A McDonald found that ARBs did not increase MI when compared with either ACE inhibitors or placebo .None of this info adds much about beta blockers. There is a more recent study comparing beta blockers directly with Arbs the LIfe study a large RCT it found no difference in MIs between the groups one treated with atenolol the other treated with losartan . The only differences significantly more stroke sin the atenolol group and significantly more diabetes in the atenolol group The Verma BMJ piece was further explored in the very same BMJ one of the rapid responses to that very article "Angiotensin receptor blockers and myocardial infarction: Analysis of evidence is incomplete and inaccurate" Mc Donald

 
Old 03-13-2010, 06:48 PM   #42
Senior Veteran
(male)
 
Join Date: Apr 2005
Location: N.Y
Posts: 705
ACE28 HB UserACE28 HB UserACE28 HB UserACE28 HB User
Re: Reducing heart rate with beta blockers in hypertension is it harmful or Atenolol?

We are getting 2 stories about ARB's. The Verma and Strauss study have caused major concerns about the safety of this class of drug. The study was carried out with careful analysis, The results were very clear from every angle. Outcomes were a major concern for ARB's compared to ACE's. The Ace studies of Perindopril and Ramipril were extremely clear and convincing. The ACE's work through a Bradykin mechanism, ARB's do not. This is more than likely why ARB's were not shown effective in MI's. ARB's do preserve kidney function, which may be a good thing. Diovan (which is the most popular ARB by far, fared the worst for MI's). Novartis has spent millions of dollars to disprove the Verma and Strauss findings. Verma and Strauss have shown the proof, and many researchers have also put in to question the efficacy of ARB's. The indication for ARB's is only if one cannot tolerate an Ace Inhibitor, an ARB can be substituted. They (unfortunately) are not the same. Differences have been shown, and ARB's are not the same as ACE's (but without the cough), Doctors are cautioned to prescribe only ACE's as a first choice, especially for heart failure.

Last edited by mod-anon; 03-13-2010 at 09:40 PM. Reason: removed quote

 
Old 03-14-2010, 04:14 AM   #43
Senior Veteran
(male)
 
jonnstar's Avatar
 
Join Date: Mar 2010
Posts: 1,873
jonnstar HB Userjonnstar HB Userjonnstar HB Userjonnstar HB Userjonnstar HB Userjonnstar HB Userjonnstar HB Userjonnstar HB Userjonnstar HB Userjonnstar HB Userjonnstar HB User
Re: Reducing heart rate with beta blockers in hypertension is it harmful or Atenolol?

Surely the "capoten cough" only effects 1 or at most 2 persons in 10..... it makes no sense to avoid ACE inhibitors for this reason when most people can take them without a problem (they are also far cheaper than the ARB's)

The doses of diuretics used these days have a minimul effect on blood electrolytes (eg HCTZ or chlorthalidone 12.5mg, Indapamide 1.5mg)

It would seem that an ACE inhibitor with a low dose diuretic (eg enalapril or lisinopril with 12.5mg of HCTZ) is a highly effective blood pressure lowering medication for those who dont suffer from "capoten cough", there is a good evidence base for end point reduction, unlikely to induce diabeties or raise cholesterol like beta blockers or high dose diuretics, unlikely to upset your electrolyte ballance, and it can be had for $4 per month at Walmart!

For the 1 or 2 in 10 who cant tolerate an ACE Inhibitor, then other drugs will obviously be needed.

Last edited by jonnstar; 03-14-2010 at 04:35 AM.

 
Old 03-14-2010, 04:31 PM   #44
Senior Veteran
(male)
 
Join Date: Apr 2005
Location: N.Y
Posts: 705
ACE28 HB UserACE28 HB UserACE28 HB UserACE28 HB User
Re: Reducing heart rate with beta blockers in hypertension is it harmful or Atenolol?

Ace Inhibitors are clearly a safer choice versus ARB's. Keep in mind that each class of HBP medication have distinct effects on hypertension, and some classes are better than others for different patients. This is for a doctor to decide. If anxiety, nervousness and panic attacks (rapid heart rates) are the culprit for hypertension, beta blockers can be highly effective. If salt sensitivity is the main culprit, Diuretics can help control hypertension. Each case can be different. Most beta blockers are now generic and extremely cheap, this includes Toprol, Bisoprolol and Carvedilol. Atenolol pricing is as low as $4.00.

 
Old 03-16-2010, 09:37 AM   #45
Junior Member
(male)
 
Join Date: Feb 2010
Posts: 15
bigvince1 HB User
Re: Reducing heart rate with beta blockers in hypertension is it harmful or Atenolol?

ARBS and ACE inhibitors have been shown to be equally effective in treating hypertension. The Verma editorial in the BMJ ;it was not even listed as a study; was criticized for cherry picking data and ignoring the two largest studies that where statistically powered to show differences. The study and it was listed as such in the BMJ published in 2005 " Angiotensin receptor blockers and risk of myocardial infarction: systematic review" McDonald looked at 19 different studies involving ace inhibitors and arbs with over 30,000 people and found no difference in MI rates between the ARBs and ACE . ARBS have equal effectiveness and less side side effects than ACE inhibitors .,.

 
Closed Thread




Thread Tools

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is Off
HTML code is Off
Trackbacks are Off
Pingbacks are Off
Refbacks are Off




Sign Up Today!

Ask our community of thousands of members your health questions, and learn from others experiences. Join the conversation!

I want my free account

All times are GMT -7. The time now is 12:37 AM.



Site owned and operated by HealthBoards.comô
Terms of Use © 1998-2014 HealthBoards.comô All rights reserved.
Do not copy or redistribute in any form!