cbrsmurf Posted March 12, 2013 Share Posted March 12, 2013 I'm in FP, some of my patients are still on atenolol (usually the ones that f/u with cardiology q6months/1yr). Is there a special subset of pts where atenolol is superior to other BB's or are these other clinicians not up to date on BBs? Am I missing something, here? Link to comment Share on other sites More sharing options...
jmj11 Posted March 12, 2013 Share Posted March 12, 2013 I know that you are speaking of cardiology, but you said "anything" so in headache work, there is still a limited use as a migraine preventative for patients with RAD as the only Beta 1 selective blocker that tends to prevent migraines. Non selective beta blockers work much better. Link to comment Share on other sites More sharing options...
CAdamsPAC Posted March 12, 2013 Share Posted March 12, 2013 There some people who use Beta Blockers for anxiety control. Link to comment Share on other sites More sharing options...
Moderator LT_Oneal_PAC Posted March 12, 2013 Moderator Share Posted March 12, 2013 FP told me "just throw atenolol in the trash." Link to comment Share on other sites More sharing options...
andersenpa Posted March 12, 2013 Share Posted March 12, 2013 http://archinte.jamanetwork.com/article.aspx?articleid=1352792 Conclusions There were no statistically significant differences in incident CV events between atenolol and metoprolol tartrate users with hypertension. Large registries similar to the one used in this analysis may be useful for addressing comparative effectiveness questions that are unlikely to be resolved by randomized trials. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted March 12, 2013 Moderator Share Posted March 12, 2013 in my experience it is cheap and effective. you can also start it without checking renal function AND LYTES unlike ACE OR DIURETICS. When I see folks in the er with the "new to area, no pcp, no insurance" story with multiple er visits for a variety of things all with high bp's I usually will start them on atenolol and try to arrange f/u. lots of these folks use the er as pcp as the avg wait for a new pcp with no insurance in my area is MONTHS. Link to comment Share on other sites More sharing options...
bradtPA Posted March 12, 2013 Share Posted March 12, 2013 Headache data shows its still useful, but I would rather prescribe carvedilol for htn or cad.... Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted March 12, 2013 Moderator Share Posted March 12, 2013 I would rather prescribe carvedilol for htn or cad.... $$$$$$$ atenolol= 4 bucks. this is the magic price, less than a pack of cigs..... as I mentioned above I see lots of folks walking around with 180/110 for months. no pcp/insurance. atenolol 25-50 QD and after a week or so they are walking around with 130/88. still no pcp/insurance but hopefully this delays their cva for a few yrs.... Link to comment Share on other sites More sharing options...
Just Steve Posted March 12, 2013 Share Posted March 12, 2013 Coreg is 4 bucks a month http://i.walmartimages.com/i/if/hmp/fusion/customer_list.pdf Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted March 12, 2013 Moderator Share Posted March 12, 2013 good to know. Thanks Steve. advantages of coreg over atenolol? Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted March 12, 2013 Moderator Share Posted March 12, 2013 just answered my own question: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1894730/ so let me rephrase: in patients with htn without chf or cardiomyopathy what is the advantage of coreg over atenolol? serious question. somebody school me. Link to comment Share on other sites More sharing options...
UGoLong Posted March 12, 2013 Share Posted March 12, 2013 In our practice, we use Coreg (carvedilol) for cardiomyopathy because it also reduces afterload and allows a greater cardiac output than you might get with a selective beta blocker. In combination with an ACEI or ARB, we often get a significant improvement of ejection fraction. We also use carvedilol in the hospital for patients with a drug abuse history and sometimes for people without cardiomyopathy when we just want a bigger stick (Coreg 25 is usually more potent than metoprolol 100). The downside of a non-selective beta blocker is primarily in diabetic patients, where you may increase their glucose levels. In the selective beta blocker world, we often use metoprolol (either the bid or XR form). If their insurance will hack it, we actually prefer Bystolic (nebivolol). Bystolic is a racemic-like mixture of a selective beta blocker (very highly selective in fact) and a vasodilator. It also seems to have fewer complaints about fatigue and sexual side effects. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted March 12, 2013 Moderator Share Posted March 12, 2013 excellent answer. Thanks. so in diabetic folks you would use atenolol over coreg but in other pt populations you would start with coreg, correct? (Assuming you can't use an ace for some reason). my typical pt population has no insurance or pcp, smokes, many have dm and substance abuse issues, most have obesity and high cholesterol. Link to comment Share on other sites More sharing options...
bradtPA Posted March 12, 2013 Share Posted March 12, 2013 Carvedilol also as a bit of action on the alpha receptor in addition to the beta, and I think that's why I have better luck controlling htn with it over even metoprolol.... Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted March 12, 2013 Moderator Share Posted March 12, 2013 Carvedilol also as a bit of action on the alpha receptor in addition to the beta, and I think that's why I have better luck controlling htn with it over even metoprolol.... thanks. at what dose do you typically start it for someone with say 6+ months of 180/110? Link to comment Share on other sites More sharing options...
Contrarian Posted March 12, 2013 Share Posted March 12, 2013 excellent answer. Thanks.so in diabetic folks you would use atenolol over coreg but in other pt populations you would start with coreg, correct? (Assuming you can't use an ace for some reason). my typical pt population has no insurance or pcp, smokes, many have dm and substance abuse issues, most have obesity and high cholesterol. Yes... Worked 3 yrs exclusively in Cardiology, with 6-11 Inter/Noninterventualist. Was taught to be CAREFUL using "Coreg" with Diabetics unless you enjoy their stories about waking up with their vehicles wrapped around poles and them being issued DUI's. ......................................................................................................................................................................................... It wasn't MY experience that it "increased" their blood glucose so much as it disabled their catacholaminergic "alarm system" that usually let them know their glucose was out of range. (The way it waas explained to me was that Our bodies use adrenaline/epi/norepi to let us know that something ain't right. Think nausea/tremor/tachycardia/diaphoresis/etc... Beta Blockers supress this very well... which is why they work well in Anxiety disorders) Had LOTs of Diabetics with Cardiomyopathy... S/P 1-2-3 AMI... that started with EF= 12-16% then after Coreg... EF 38-45%... After a few horror stories about them "waking up" after a accident in the car or at the Hospital/Police Station, I started teaching them to check the FSBG BEFORE driving. And only continue to use the BB's in those willing to trade the higher EF for increased testing frequency. Link to comment Share on other sites More sharing options...
bradtPA Posted March 12, 2013 Share Posted March 12, 2013 thanks. at what dose do you typically start it for someone with say 6+ months of 180/110? I would start at 3.125 mg and taper it weekly until it reached 12.5 mg BID, then recheck before advancing further. I am almost always using it as an add-on to lisinopril, especially with 180/110s (stage II HTN), they will normally take 2+ agents to control them, for my indigent population. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted March 12, 2013 Moderator Share Posted March 12, 2013 Thanks C. I have never worked full time in primary care so my basic htn management algorithm kind of looks like this: DM ACEI (if no contraindication) or ARB African Americans start with CCB General population Beta blocker first line then add diuretic prn unless very athletic then ACEI or CCB first concurrent BPH consider alpha blocker tx resistant htn add clonidine Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted March 12, 2013 Moderator Share Posted March 12, 2013 I would start at 3.125 mg and taper it weekly until it reached 12.5 mg BID, then recheck before advancing further. I am almost always using it as an add-on to lisinopril, especially with 180/110s (stage II HTN), they will normally take 2+ agents to control them, for my indigent population. Thanks. 3.125 QD or BID to start? Link to comment Share on other sites More sharing options...
bradtPA Posted March 12, 2013 Share Posted March 12, 2013 Twice a day Link to comment Share on other sites More sharing options...
Contrarian Posted March 12, 2013 Share Posted March 12, 2013 Just remember that "Carvedilol" is BID and "Metoprolol" is QD... So for minimally complient patients... you may want to consider metoprolol because getting them to take a med BID has been historically problematic... Link to comment Share on other sites More sharing options...
cbrsmurf Posted March 12, 2013 Author Share Posted March 12, 2013 Wait, you guys are using BB's first-line for HTN? I am pretty sure all the landmark studies show that pts have better outcomes with thiazides and acei/arbs. From the studies I have been looking at, BB's outcomes are weak or only slightly better than placebo. And from what I've heard, atenolol actually stands out from beta blockers because there is no evidence of improved outcome at all -- which I guess caused a big commotion several years ago since it was in the top 3 most Rx'd drug several years ago. I definitely need to do more reading, but what are your guys' thoughts/findings? Link to comment Share on other sites More sharing options...
andersenpa Posted March 12, 2013 Share Posted March 12, 2013 Headache data shows its still useful, but I would rather prescribe carvedilol for htn or cad.... For uncomplicated HTN? Link to comment Share on other sites More sharing options...
andersenpa Posted March 12, 2013 Share Posted March 12, 2013 just answered my own question:http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1894730/ so let me rephrase: in patients with htn without chf or cardiomyopathy what is the advantage of coreg over atenolol? serious question. somebody school me. I'm not aware of using it outside of HF, LV dysfunction, or complicated HTN. Link to comment Share on other sites More sharing options...
cbrsmurf Posted March 12, 2013 Author Share Posted March 12, 2013 found a couple of pertinent articles study on atenolol: http://www.thelancet.com/journals/lancet/article/PIIS0140673604173558/abstract study on beta blockers and diabetes http://www.ajconline.org/article/S0002-9149(07)01332-X/abstract Link to comment Share on other sites More sharing options...
Recommended Posts
Archived
This topic is now archived and is closed to further replies.