Abstract 425: The Effectiveness Of Metoprolol Versus Atenolol On Prevention Of All-cause And Cardiovascular Mortality In A Large Chinese Population: A Cohort Study
Background: Existing trials almost exclusively used atenolol to represent the entire beta-blocker class. We compared the incidence of all-cause and cardiovascular (CVS) mortality, blood pressure (BP) control and adherence levels between patients newly prescribed atenolol vs. metoprolol.
Methods: This cohort study included all public, clinical settings in Hong Kong between 2001 and 2005, followed up till 2010. We compared outcomes between 22,479 new atenolol users and 29,972 new metoprolol users. The difference in mortality between drugs was evaluated by Cox proportional hazard regression models. Binary logistic regression analyses were used to compare the BP control rates and adherence levels.
Results: Among atenolol and metoprolol users, 7.0% (1,577 of 22,479) and 13.1% (3,940 of 29,972) died, respectively (p<0.005). The incidence of CVS mortality among atenolol users was lower than metoprolol users (1.4% vs. 3.7%, p<0.001). When compared with atenolol users, metoprolol users were 1.13-fold (95% C.I. 1.06-1.20) and 1.56-fold (95% C.I. 1.27-1.90), respectively, more likely to encounter all-cause and CVS mortality; less likely to be drug adherent (Adjusted Relative Risk [RR]: 0.95, 95% C.I.: 0.90-0.99, p=0.013); and less likely to achieve optimal overall BP control (RR 0.94, 95% C.I. 0.90-0.99, p=0.023) and diastolic BP control (RR 0.86, 95% C.I. 0.77-0.97, p=0.013).
Conclusions: These findings imply an intra-class difference for beta-blockers when used as first-line antihypertensive prescriptions in real-life clinical settings. More outcome studies on the effectiveness of different subtypes within other major antihypertensive drug classes are warranted.
Author Disclosures: M.C. Wong: None. W.W. Tam: None. X. Lao: None. H.H. Wang: None. M.W. Kwan: None. C.S. Cheung: None. E.L. Tong: None. N. Cheung: None. B.P. Yan: None. C. Yu: None. S.M. Griffiths: None.
- © 2014 by American Heart Association, Inc.