The Bittersweet Sounds of the Modern Food Chain

Background: A recent meta-analysis of drug effects in patients with hypertension claims that all β-adrenergic blockers are equally effective but less so than other antihypertensive drugs. Published comparisons of the β-adrenergic blocker atenolol and non-atenolol β-adrenergic blockers indicate different effects on death rates, arrhythmias, peripheral vascular resistance and prognosis post myocardial infarction, all in disfavour of atenolol. In keeping with these findings, the data presented in the meta-analysis indicate that atenolol is less effective than the non-atenolol β-adrenergic blockers both when compared with placebo and with other antihypertensive drugs. These findings were not, however, statistically significant. Methods: We performed an additional analysis with a Bayesian statistical method in order to make further use of the published data. Results: Our calculations on the clinical data in the meta-analysis showed 13% lower risk (risk ratio 0.87) of myocardial infarction among hypertensive patients taking non-atenolol β-adrenergic blockers than among hypertensive patients taking atenolol. The 90 % credibility interval ranged from 0.75 to 0.99, thereby indicating statistical significance. The probability of at least 10% lower risk (risk ratio ≤ 0.90), which could be considered to be of clinical interest, was 0.69. Conclusion: Taken together with the other observations of differences in effects, we conclude that the claim that all β-adrenergic blockers are inferior drugs for hypertensive patients should be rejected. Atenolol is not representative of the β-adrenergic blocker class of drugs as a whole and is thus not a suitable drug for comparisons with other antihypertensive drugs in terms of effect. The non-atenolol β-adrenergic blockers should thus continue to be fundamental in antihypertensive drug treatments. Background In a recent meta-analysis, Lindholm, Carlberg and Samuelsson claim that, in patients with hypertension, the βadrenergic blocker atenolol is no different from other βadrenergic blockers in terms of effects on hard endpoints [1]. This assertion brings to mind the HAPPHY trial [2] in which patients on atenolol showed higher death rates and patients on metoprolol lower death rates than did patients taking diuretics. The difference between the two Published: 8 May 2007 BMC Clinical Pharmacology 2007, 7:4 doi:10.1186/1472-6904-7-4 Received: 14 February 2006 Accepted: 8 May 2007 This article is available from: http://www.biomedcentral.com/1472-6904/7/4 © 2007 Aursnes et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.