Which is better, carvedilol or atenolol?
I learned this week that we often prescribe particular medications within a class based on what we were exposed to during our training. It occurs to me that I almost never prescribe atenolol, and I wondered if I should be doing that more. This meta-analysis looked at several beta-blockers in patients with heart failure and after MI, and it found that carvedilol confers a mortality benefit in patients with heart failure (potentially also after acute MI depending on the statistical approach used). The head to head trial examining atenolol versus carvedilol post-MI did not find a mortality difference, and carvedilol did not appear clearly superior to bisoprolol nor nebivolol. The discussion section from this article nicely touches on the anti-arrhythmic and insulin sensitivity effects of carvedilol and is worth a read. Regarding my specific question about atenolol, I particularly appreciated this sentence from the discussion explaining its generally poor data: "The fact that atenolol continues to be 1 of most widely prescribed BBs (presumably because of habit) is indefensible from a scientific perspective." Entertainment aside, this is an older paper so it is admittedly hard to confidently extrapolate its conclusions to practice today, but, I enjoyed the review of some major BB trials, and I believe you will, too.
DiNicolantonio JJ, Lavie CJ, Fares H, Menezes AR, O’Keefe JH. Meta-Analysis of Carvedilol Versus Beta 1 Selective Beta-Blockers (Atenolol, Bisoprolol, Metoprolol, and Nebivolol). The American Journal of Cardiology. 2013;111(5):765-769.
