Document Detail

Comparative effectiveness of 2 β-blockers in hypertensive patients.
MedLine Citation:
PMID:  22928181     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Randomized controlled trials have demonstrated the efficacy of selected β-blockers for preventing cardiovascular (CV) events in patients following myocardial infarction (MI) or with heart failure (HF). However, the effectiveness of β-blockers for preventing CV events in patients with hypertension has been questioned recently, but it is unclear whether this is a class effect.
METHODS: Using electronic medical record and health plan data from the Cardiovascular Research Network Hypertension Registry, we compared incident MI, HF, and stroke in patients who were new β-blocker users between 2000 and 2009. Patients had no history of CV disease and had not previously filled a prescription for a β-blocker. Cox proportional hazards regression was used to examine the associations of atenolol and metoprolol tartrate with incident CV events using both standard covariate adjustment (n = 120,978) and propensity score-matching methods (n = 22,352).
RESULTS: During follow-up (median, 5.2 years), there were 3517 incident MI, 3272 incident HF, and 3664 incident stroke events. Hazard ratios for MI, HF, and stroke in metoprolol tartrate users were 0.99 (95% CI, 0.97-1.02), 0.99 (95% CI, 0.96-1.01), and 0.99 (95% CI, 0.97-1.02), respectively. An alternative approach using propensity score matching yielded similar results in 11,176 new metoprolol tartrate users, who were similar to 11,176 new atenolol users with regard to demographic and clinical characteristics.
CONCLUSIONS: There were no statistically significant differences in incident CV events between atenolol and metoprolol tartrate users with hypertension. Large registries similar to the one used in this analysis may be useful for addressing comparative effectiveness questions that are unlikely to be resolved by randomized trials.
Emily D Parker; Karen L Margolis; Nicole K Trower; David J Magid; Heather M Tavel; Susan M Shetterly; P Michael Ho; Bix E Swain; Patrick J O'Connor
Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Archives of internal medicine     Volume:  172     ISSN:  1538-3679     ISO Abbreviation:  Arch. Intern. Med.     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2013-01-30     Completed Date:  2013-03-25     Revised Date:  2014-08-06    
Medline Journal Info:
Nlm Unique ID:  0372440     Medline TA:  Arch Intern Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1406-12     Citation Subset:  AIM; IM    
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MeSH Terms
Adrenergic beta-Antagonists / therapeutic use*
Aged, 80 and over
Follow-Up Studies
Heart Failure / epidemiology*,  etiology
Hypertension / complications,  drug therapy*
Middle Aged
Myocardial Infarction / epidemiology*,  etiology
Proportional Hazards Models
Randomized Controlled Trials as Topic
Stroke / epidemiology*,  etiology
Treatment Outcome
Grant Support
Reg. No./Substance:
0/Adrenergic beta-Antagonists
Comment In:
Arch Intern Med. 2012 Oct 8;172(18):1412-14   [PMID:  22928183 ]

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