β-Blockers and Primary Prevention of Coronary Heart Disease in Patients With High Blood Pressure

Abstract

We conducted a population-based, case-control study to determine whether beta-blockers, used for the treatment of hypertension, prevent first events of coronary heart disease. Cases were patients who had high blood pressure treated with medicines and who presented in 1982 to 1984 with angina or fatal or nonfatal myocardial infarction. Controls were a probability sample of health maintenance organization patients with pharmacologically treated hypertension and free of coronary heart disease. Blinded to case-control status, we reviewed the medical records of the 248 cases and 737 controls. The health maintenance organization's computerized pharmacy database was used to ascertain the use of beta-blockers. Fewer cases than controls were taking beta-blockers. This difference was confined to those with nonfatal infarctions. After adjustment for confounding, the estimated relative risk was 0.62 (95% confidence interval, 0.39 to 0.99). Higher doses of beta-blockers conferred greater protection. We conclude that beta-blockers may prevent first events of nonfatal myocardial infarction in patients with high blood pressure.

Quantitative Application to a Polypill by the Development of Stability Indicating LC Method for the Simultaneous Estimation of Aspirin, Atorvastatin, Atenolol and Losartan Potassium

“…Atenolol (ATL), (RS)-2-{4-[2-hydroxy-3-(propan-2-ylamino) propoxy]phenyl} acetamide is a beta1-selective (cardio selective) beta-adrenergic receptor blocking agent without membrane stabilizing or intrinsic sympathomimetic (partial agonist) activities. This preferential effect is not absolute, however, and at higher doses, Atenolol inhibits beta2-adrenoreceptors, chiefly located in the bronchial and vascular musculature [10][11]. Losartan (LST), 2-butyl-4-chloro-1-{[2'-(1H-tetrazol-5-yl)biphenyl-4-yl]methyl}-1 H-imidazol-5-yl) methanol is an angiotensin II receptor (type AT1) antagonist.…”

Conducting Comparative Effectiveness Research on Medications: The Views of a Practicing Epidemiologist from the Other Washington

“…My first epidemiologic study was an observational case-control study of the association between anti-hypertensive drug use and the risk of coronary heart disease [4,5]. At the time, randomized trials that had evaluated high-dose diuretics against placebo in patients with hypertension showed reduced risks of major cardiovascular events [6].…”

Conflict of Interest, Disclosure, and Trial Reports

“…1 The other suggested that, compared with the use of high-dose diuretics, which is now no longer recommended, the use of ␤-blockers might be associated with a lower risk of coronary events in hypertensive patients. 2 While the news media's coverage of the risk study was transient, the pharmaceutical industry had a more sustained interest in the other publication.…”