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ACE28 · 02-17-2010, 06:59 AM

According to the Cardiology publication, which was published approximtely 1 year ago (J AM Coll Cardiology 52:1482).

Atenolol is the most popular and worst beta blocker currently prescribed,
and should not be a choice for anyone with hypertension.

Atenolol has fared the worse in comparison to some beta blockers, The researchers and doctors from St. Lukes Medical and other Major medical centers said that the Vasodilating beta blockers should be the only ones used if a beta blocker is the choice. Atenolol has been compared with one of the newer vasodilating beta blockers, Nebivolol (Bystolic), and it was found that atenolol increases the central aortic pressure but nebivolol does not.
The newer vasodilating beta blockers do not have any of these detrimental effects. Because they are vasodilatory, they may well offset the slowing of heart rate by decreasing cardiac wave reflection from the periphery and, in the case of nebivolol, by releasing nitric oxide, an endogenous vasodilator with antiatherogenic activity. Dr. Messerli states that if you need to take a beta blocker, please use a vasodilating one such as carvedilol or nebivolol.
He also states that Beta blockers in hypertension are not very useful, and you probably should use any other single drug first before you add a beta blocker.

What the newest research is showing is that slowing the heart rate with beta blockers in people with hypertension is associated with an increased risk of cardiovascular events and death. But experts point out the analysis was done mainly with studies that used atenolol and that it remains to be determined whether it is this drug or the reduction in heart rate that is harmful.

For patients with MI and heart failure, beta blockers are the best drugs. What the studies are showing is that in hypertension, when you slow down the heart rate with a beta blocker, it actually shortens your life expectancy, it causes more heart attacks, more heart failure, and more strokes. For hypertension only, the results are negative. Research shows that Atenolol, "has been tried and found guilty, and yet around 40% of prescriptions for beta blockers in the UK and in the US are still for atenolol. Atenolol should not be given to anybody. Nobody disagrees that atenolol is guilty, and yet we are still using it."

My opinion of this latest news is that it's possible that Atenolol is not the best drug for hypertension, but this does not prove that any other medications are better or safer. The number of patients on Atenolol is huge, possibly millions of people. I wonder how much of this article has to do with Pharmaceutical tainted MD's, who have a vested interest in promoting newer drugs or beta blockers. To think that a cheap generic drug (Atenolol), controls almost 50% of all prescriptions written worldwide, might motivate drug companies to discredit the drug to promote other newer brand medications. If Atenolol gains about another 15% of market share, it may very well force many Pharmaceutical companies into bankruptcy.

Machaon · 02-17-2010, 09:08 AM

Quote:

Originally Posted by ACE28

... Dr. Messerli states that if you need to take a beta blocker, please use a vasodilating one such as carvedilol or nebivolol.

I vote for Carvedilol (Coreg)! It really keeps my blood pressure under control. It slows my heart rate, but I don't mind that at all.

Quote:

He also states that Beta blockers in hypertension are not very useful,

I realize that everyone is different, but Carvedilol, along with my very healthy diet, exercise and avoiding irritants, keeps my blood pressure at very health levels, and it is the only blood pressure med that I take.

The proof is in the pudding!

Quote:

What the newest research is showing is that slowing the heart rate with beta blockers in people with hypertension is associated with an increased risk of cardiovascular events and death.

In clinical trials, Carvedilol has shown to improve the health of the heart and the patient.

Quote:

For patients with MI and heart failure, beta blockers are the best drugs.

An interesting contradiction. The research also showed that Beta Blockers "are associated with an increased risk of cardiovascular events and death"?!

Quote:

What the studies are showing is that in hypertension, when you slow down the heart rate with a beta blocker, it actually shortens your life expectancy, it causes more heart attacks, more heart failure, and more strokes.

In many large and small scale clinical trials, Carvedilol has shown to improve the health of the heart and the patient.

I really appreciate and enjoy the effects of Carvedilol on my Heart Failure, my Blood Pressure and my overall health. While this is strictly anecdotal on my part, I can't believe that I am the only one who is benefiting greatly from Carvedilol.

Quote:

I wonder how much of this article has to do with Pharmaceutical tainted MD's, who have a vested interest in promoting newer drugs or beta blockers.

BINGO! An interesting point that could well be the explanation! Good point! Good insight on your part!

Thanks for producing another one of your interesting posts! Take care...

ACE28 · 02-17-2010, 11:57 AM

McMahon - Beta blockers are undisputed as the best treatment for heart failure and coronary Issues. The article questions the benefits when used for hypertension. The article also mentions that beta blockers are still very effective in men around 50 years old or younger. This is due to some hemodynamic effect in peripheral circualtion and pulse rates for younger men. The article appears to be an all out attack on Atenolol (mainly). As we know, not all beta blockers are created equal, and Carvedilol and Toprol are the only beta blockers currently approved for heart failure by the FDA. Most beta blockers were never tested for heart failure in clinical trials. With the exception of Bucindolol which showed almost no benefit in heart failure and Nebivolol which was effective but did not show such robust numbers, and Bisoprolol which is as effective as Toprol and Carvedilol but not yet approved in the U.S. only in the U.K.

The article mentions that amlodipine and perindopril were more effective then Atenolol and a diuretic on some end points. If any medication is combined with such a highly effective drug as Perindopril in huge clinical trials, the results would be very positive. If amlodipine was also combined with a diuretic, the results versus Atenolol would have been worse.

Once again, I beleive much of the attack on Atenolol is industry funded. It seems Atenolol is the most researched drug in over 800 clinical trials. It appears very easy to find many negative studies to smear the drug's
reputation. With all these research trials, their has to be some negatives. Their are many drugs that were never tested in Clinical trials, and some only tested once with a very short term trial and they are being prescribed everyday. I would rather take Atenolol if I had a choice among some newer untested drug. Because a pill was not found to be dangerous in only one study, does not prove that the pill is any better or worse than others.

mabent · 02-18-2010, 06:21 AM

Hi - I agree with Macheon that Carvedilol is beneficial for hypertension without heart failure. My doctor specifically mentioned the fact that I do not have heart failure.
My cardiologist changed my prescription from Bystolic to Carvedilol 12.5mg to be taken twice a day. I am also taking other drugs , which I talk about in my thread on Tekturna.
My blood pressure has improved and is now under control for the first time in years.
I do have some stenosis in one of my kidneys. I know that Bystolic has worked for Ace and others; but the main thing I wanted to mention is that it is also prescribed for things other than heart failure without bad effects.

ACE28 · 02-18-2010, 06:43 AM

Mabent - I'm glad to hear that Carvedilol is working for you. It seems some drugs can lose their effectiveness in controlling hypertension after awhile. This is why doctors are always increasing the dose. Some drugs are also more potent than others, and long term effectiveness is great. Atenolol has been prescribed for years to control high blood pressure, with good results.
I think this article is making patients and MD's think twice about Atenolol.

According to the latest beta blocker research, the best beta blockers to be taking are the vasodilating blockers, these include Carvedilol, Labetalol and Nebivolol. Your doctor was correct to suggest Carvedilol as an alternative for better blood pressure control. Your doctor seems to be "right on track" with the latest beta blocker studies..

mabent · 02-18-2010, 04:37 PM

Thanks, Ace. I sure hope that all doctors will study thoroughly each drug to make sure it's the right one to give any particular patient and, if it proves not to be, will research thoroughly every drug he/she substitutes, especially the newer ones! Mabent

ACE28 · 02-19-2010, 06:42 AM

Mabent - We have to hope that our doctors have our best interests in mind, and also the insights to see thru the negative controversial articles being published, and the pharmaceutical sales teams. When I mention to my doctor the news of recent drug controversies etc., he will respond almost 100% of time with the answer "That has not been proven". Smart doctors see through the hype. My doctor seems to base most of his approaches on 40 + yeaars of experience as a Cardiologist. When he tells me that Toprol XL is the best beta blocker in his many years of clinical experience, and Atenolol is a good substitute. I think the basis is proven experience. Yet, we read these negative articles on some of the beta blockers including Metoprolol, and we are left puzzled and worried. Yet, both Atenolol and Metoprolol have withstood the test of time, prescribed to millions of hypertensive patients since the 1960's and many are still alive. Will the newer pill's being pushed by the Pharm. Industry and the Media, prove their safety and effectiveness for more than 10 years, let alone 40 + years. As I mentioned in a previous topic, Bystolic (newest drug) was rejected recently by the FDA for heart failure indication, The mortality numbers were not robust enough, and did not show the effectiveness of Toprol XL in all areas studied. Bystolic is the newest recommended pill, which the Scientific journals and articles fully endorse, but yet it cannot be recommended at this time for anything other than high blood pressure. It's confusing. This is why, to a large degree, we need to adhere to our doctors recommendations, be honest and always keep him in the loop. My doctor is not against prescribing Bystolic or Carvedilol, (I'm currently on Bystolic) but his clinical experience favors Toprol XL.

bigvince1 · 02-23-2010, 09:08 AM

You know it is troubling when physicians are slow to realize that the drug they are using simply does not work. Atenolol is a perfect example . When used forhypertension it simply has not be show to prevent heart attacks or deaths compared to placebo. Yet it is still widely used. Why does it not work who knows it does not reduce central blood pressure as well as other drugs it causes diabetes it causes weight gain it does reduce blood pressure inthe arm a little. The fact that people use this drug and many are alive really does not say much the they would be alive anyway. It would be difficult to find a hypertension expert who would recommend this drug. Why it simoly does not work very well.

ACE28 · 02-24-2010, 05:48 PM

I still believe certain beta blockers and ace inhibitors are the best of the bunch. They are approved for the most indications, from hypertension to heart failure. Diuretics deplete many essential minerals and Calcium Blockers
have never been shown to improve mortality in the few large studies conducted. According to many cardiologists and alternative doctors, beta blockers prevent MI especially in the morning hours when Mi's are more frequent, upon waking the normal heart rate can greatly increase to dangerous levels, and especially if added stress or anxiety is part of the morning routine. Beta blockers decrease that dangerous surge of adrenaline.

bigvince1 · 02-25-2010, 07:37 AM

Atenolol in particular does not appear to be an effective drug when used to treat hypertension. A study "Atenolol in hypertension: is it a wise choice. published in the Lancet 2004 found that Atenolol was no better than placebo at preventing MI; Deaths,or cardiovascular mortality when compared to placebo when compared other anti hypertensive medications the atenolol group had higher rates of death'; cardiovascular mortality ;and stroke.

Machaon · 02-25-2010, 09:58 AM

Quote:

Originally Posted by mabent

Hi - I agree with Machaon that Carvedilol is beneficial for hypertension without heart failure. My doctor specifically mentioned the fact that I do not have heart failure.

Carvedilol is the most effective, longest lasting and most beneficial Beta Blocker on the market for many different health and heart problems, including High Blood Pressure.

OTOH, Heart Failure doesn't usually cause High Blood Pressure, it's the other way around: High Blood Pressure causes Heart Failure, so it makes sense that Carvedilol would be effective against High Blood Pressure, whether one has Heart Failure or not.

The problem with Carvedilol, or Atenolol, or any other heart medication is that Beta Blockers, and other heart medications, only treat the symptoms, not the underlying cause of the affliction. As long as the cause of the heart disease is not remedied, the health problems will only continue to get worse, slowly resulting in the need for increased dosages of the medications until they become no longer effective.

ACE28 · 02-26-2010, 07:46 AM

Quote:

Originally Posted by bigvince1

Atenolol in particular does not appear to be an effective drug when used to treat hypertension. A study "Atenolol in hypertension: is it a wise choice. published in the Lancet 2004 found that Atenolol was no better than placebo at preventing MI; Deaths,or cardiovascular mortality when compared to placebo when compared other anti hypertensive medications the atenolol group had higher rates of death'; cardiovascular mortality ;and stroke.

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. The articles never mention that long term use of the many other classes of HBP drugs are either unknown, or known to cause Kidney failure, stroke, MI, and liver failure. In a study reported by the BMJ, The ARB Diovan (also one of the post popular drugs)was shown to greatly increase the heart attack risk, when compared to Ace Inhibitors. Does this apply to all ARB'S??? Who knows.... Is it safer than Atenolol??

ACE28 · 02-26-2010, 07:52 AM

Machaon - You are a very strong advocate for Carvedilol, and for very good reason. You've seen great improvements and feel better. Do you take the brand name drug COREG? or the generic Carvedilol?? Their is also an Extended Release Version Available....

Machaon · 02-26-2010, 09:41 AM

Quote:

Originally Posted by ACE28

Machaon - You are a very strong advocate for Carvedilol, and for very good reason. You've seen great improvements and feel better.

Your are correct about the effects of Coreg on my health. But, the reason why I asked my Cardiologist to write me a prescription for Coreg was because of the 58 +/- clinical trials for which I have spent much time reading; plus many other articles extolling the virtues of Coreg. The more that I read about Coreg, the more that I was amazed by it's unique and powerful ability to improve one's Blood Pressure, Heart Failure, Heart Disease and many other health problems. It's kinda a health elixir. I love it!

Quote:

Do you take the brand name drug COREG? or the generic Carvedilol??

Carvedilol! It's $4 for a month's supply, $10 for three months. Cheap! Cheaper! Cheapest!

In these days of high cost medical care, it costs me very little to care and greatly improve my Heart Failure, High Blood Pressure, Permanent Atrial Fibrillation, Valve Disease and overall health. At one time I wasn't sure that I was going to live to 60. At this time, I am not sure that I can survive these nasty health problems to 80, but as long as my health is improving, and I've got a good quality of life, there's hope.

Quote:

Their is also an Extended Release Version Available....

There is absolutely no benefit to the Extended Release Version, IMHO. The old, original Coreg has been thoroughly tested once per day, and twice per day, and it does just fine either way, as per my reading of the clinical trials.

ACE28 · 02-26-2010, 05:32 PM

Machaon - Focus on the 100 mark (God Willing). Remember 100 is the new 80.

Machaon · 02-27-2010, 08:50 AM

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.

ACE28 · 02-27-2010, 05:42 PM

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.

bigvince1 · 02-28-2010, 09:30 AM

Quote:

Originally Posted by ACE28

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.

ACE28 · 03-01-2010, 06:53 AM

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.

mabent · 03-01-2010, 04:04 PM

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!

Mabent

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