Recent guideline from ISH says for treatment of hypertension
any drug that the patient can take and
afford is OK. But In last few years the atenolol has been projected as villain,
so most doctors have started moving away from prescribing atenolol and some
patient also want their atenolol to be changed to other drugs.
In recent both JNC 8 and ISH guidelines, beta blockers are
no more preferred drugs for treating hypertension, they have been pushed far
down in algorithm.
Both Metoprolol and atenolol are beta one selective
blocker. Now most pharmaceutical
companies have come with combination of amlodipine and Metoprolol before these
companies use to promote amlodipine with atenolol.
|ISH/ASH guidlines for hypertension|
Lovers of Metoprolol over the atenolol claimed, lipophilic
Metoprolol can cross the blood brain barrier and may give extra CNS benefits
over the atenolol. To check CNS benefits of Metoprolol over atenolol, heart
rate variability was assessed during stress and exercise, in this study both
atenolol and Metoprolol did attenuate heart rate variability, but there was no
difference between them. This suggested that, when CNS is active there is no
clinical appreciable extra action of Metoprolol over atenolol click here
There are no RCTs to compare head to head atenolol versus
Metoprolol in treatment of hypertension in terms out comes, but retrospective
registry analysis have shown either of the molecules is same in treating
. In this study there was no difference in CV events, morality and stroke
between atenolol and Metoprolol.
In a study comparing vascular effects of Atenolol versus Metoprolol
Atenolol showed increased peripheral augmentation
index as compared to Metoprolol. This increase in augmentation index is
associated increased CV events according some studies but few other studies are
against this opinion. The increase in augmentation index with atenolol is due
to decreased heart rate and increased peripheral vascular resistance. I think when atenolol or Metoprolol is not
used as first line drug, when ether is combined with Ca channel or other vasodilators,
benefits of Metoprolol over atenolol in terms vascular benefits may not be that
Atenolol combination with amlodipine is also much cheaper
than Metoprolol so I think at least in patients with poor financial status this
drug could be still used.