Wiersma Tj, Verduijn MM, Bouma M, Goudswaard AN. NHG still prefers metoprolol. Huisarts Wet 2008;51(6):283-6.
In response to a meta-analysis investigating the effects of atenolol in patients with hypertension, at the end of 2004 the Dutch College of General Practitioners advised a halt on the prescription of atenolol and that metoprolol should be preferred when a beta-blocker is required. This advice met with some criticism, it being argued that not only should atenolol be scrapped but also that all beta-blockers should be avoided because of their lower effectiveness, especially in the elderly.
Since 2004 some new meta-analyses have appeared investigating the efficacy of atenolol and other beta-blockers and comparing them with the efficacy of other classes of antihypertensive drugs. One meta-analysis concluded that all beta-blockers perform less well than antihypertensive drugs belonging to other groups. This is especially due to their lower effectiveness in preventing strokes. This conclusion however, relies heavily on atenolol trials, while atenolol performs less well than non-atenolol beta-blockers.
Another meta-analysis suggests that beta-blockers do not perform well in elderly patients but that they do perform as well as other antihypertensive drugs in patients below the age of 60. This result also relies heavily on atenolol trials. Meanwhile the confidence intervals of the results in older and younger patients show considerable overlap.
More recently (2006) a Cochrane review appeared investigating the same questions. Again it was found that beta-blockers are in some respects less advantageous than diuretics, calcium channel blockers, ACE inhibitors or angiotensin receptor antagonists. About 75% of the evidence regarding beta-blockers is derived from patients using atenolol. Because of the scarcity of data on non-atenolol beta-blockers it is impossible to decide whether the results of the review should be considered as an effect of atenolol only or as a class effect of all beta-blockers.
At present the advice of the Dutch College of General Practitioners to halt the prescription of atenolol can be maintained.