Beta Blockers: Good, Bad, or Indifferent? Part 2

Alvin B. Lin, MD, FAAFP
Dr. Lin is an associate professor of family and community medicine at University of Nevada School of Medicine and an adjunct professor of family medicine and geriatrics at Touro University Nevada College of Medicine. He also serves as an advisory medical director for Infinity Hospice Care and as medical director of Lions HealthFirst Foundation. Dr. Lin maintains a small private practice in Las Vegas, NV. The posts represent the views of Dr. Lin, and in no way are to be construed as representative of the above listed organizations. Dr. Lin blogs about current medical literature and news at

Drug effect or class effect?  Pharmaceutical manufacturers would like you to believe that their medication is just a bit more special than the competitor's product. Insurers would like you to believe that less expensive older generics are just as good as newer brand name drugs. Kinda reminds me of me. After all, I'd like you to believe that I'm just a bit better than your average family doc & geriatrician. But the truth is, we're all pretty darn good at what we do (thank goodness!).

So back to drugs. Yesterday, we noted that beta blockers in general don't make a hill of beans with regards to heart disease & risk factors. In a comparative analysis published earlier this week in the Archives of Internal Medicine, the authors followed 120,978 hypertensive individuals (over 91% of whom were taking atenolol vs 9% on metoprolol tartrate) of which 11,176 atenolol users were matched to the same number of metoprolol tartrate users. It should be noted that there are actually two forms of metoprolol, the twice-daily tartrate form studied here and the once-daily succinate form, compared to once-daily atenolol.

After following these participants for over five years, the authors concluded that there was no difference in the rate of new cardiovascular events, eg heart attack, heart failure, & stroke, between use of these two beta blockers. But if you ask me, it's a lot easier to take medicine once daily rather than twice daily. Of course, this study does nothing to address the use of carvedilol & nebivolol.