Metoprolol 200mg modified-release / Hydrochlorothiazide 25mg tablets

BackgroundHypertension (HTN) is a global public health issue, with high prevalence and a significant impact on cardiovascular morbidity and mortality. Cardioselective beta-blockers, such as atenolol, are widely used in the treatment of HTN, although their indication as first-line therapy remains controversial.ObjectiveTo evaluate the efficacy and safety of atenolol in the treatment of primary HTN, compared with other first-line classes of antihypertensive drugs.MethodsA systematic review was conducted based on a research question structured using the PICO format. Randomized clinical trials comparing atenolol with other antihypertensive agents were included. Searches were performed in three international databases. Methodological quality was assessed using the RoB 2 tool, and the certainty of evidence was rated using the GRADE system. The primary composite outcome was the occurrence of major cardiovascular events. Secondary outcomes included all-cause mortality, acute myocardial infarction, and stroke, each analyzed separately.ResultsSeven clinical trials met the inclusion criteria. Compared with amlodipine and losartan, atenolol was associated with a slightly higher incidence of cardiovascular events, with low and moderate certainty of evidence, respectively. The combination of hydrochlorothiazide and amiloride demonstrated a greater reduction in cardiovascular events compared to atenolol, although with very low certainty of evidence. Blood pressure (BP) reduction was similar across the compared treatments.ConclusionsDespite the limitations of available evidence, atenolol showed comparable efficacy in BP reduction, with small differences in cardiovascular outcomes favoring other antihypertensive classes. Its use may be considered among the options for combination therapy in the treatment of primary HTN in adults. Other beta-blockers were not evaluated in this systematic review.

Abstract licence: CC BY

Cardiovascular conditions disrupt the normal functioning of the heart and blood vessels, often due to underlying conditions like atherosclerosis or hypertension. Antihypertensive medications are essential in cardiovascular disease management, encompassing several major drug classes with distinct mechanisms of action. Hence, this review evaluated the impact of various antihypertensive treatments on cardiovascular event reduction in asymptomatic carotid artery stenosis (CAS) patients. A comprehensive literature search was conducted from inception to 2024 on various databases by using specific keywords, and based on the eligibility criteria, three observational cohort studies and six randomized controlled trials (RCTs) of the 540 records retrieved were incorporated in this systematic review. The Newcastle-Ottawa scale was used to assess the methodological quality of the cohort studies, and the risk of bias visualization tool was used for RCTs. Data were then systematically extracted and analyzed. The results reported that enalapril and fosinopril demonstrated dual benefits in blood pressure (BP) reduction and vascular remodeling, though meta-analysis showed statistically insignificant improvements in regional cerebral blood flow (CI: -0.84, 6.08, P = 0.14, I2= 94%). Similarly, isradipine, lacidipine, and amlodipine improved carotid hemodynamics and cerebral perfusion, with meta-analysis favoring calcium channel blocker intervention for blood pressure management (CI: -3.25 to 7.64, P = 0.43). On the other hand, thiazide diuretics effectively reduced BP but showed limited efficacy in preventing atherosclerosis progression. In addition, angiotensin II receptor blockers (ARBs) significantly reduced 5-year stroke rates from 11% to 3.5%. Moreover, beta-blockers showed specific benefits, with metoprolol improving plaque echogenicity (57.3 ± 16.8 vs. 51.8 ± 20.0, p = 0.006) and reducing cardiovascular events (17% vs. 37% placebo, p = 0.011), while labetalol effectively managed post-endarterectomy hypertension. In conclusion, antihypertensive treatments showed varying effectiveness in cardiovascular event reduction and improvements in vessel measures.

Abstract licence: CC BY