NEW YORK (Reuters Health) – Amlodipine-based therapy is still a better treatment for uncomplicated hypertension than atenolol-based therapy, even in patients with higher baseline heart rates, according to a report in the Journal of the American College of Cardiology for September 22.

Some guidelines for hypertension management have suggested that beta-blockers should be a first-line therapy in patients with relative tachycardia in order to reduce their increased sympathetic tone. Trial data supporting the benefits of this approach over non-beta-blocker regimens, however, is lacking, lead author Dr. Neil R. Poulter, from Imperial College London, and colleagues note.

The main analysis of the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA) study indicated that in general, amlodipine-based therapy is superior to atenolol-based therapy in patients with uncomplicated hypertension. Whether this extended to the subgroup with higher baseline heart rates was unclear.

The current analysis of ASCOT-BPLA included data from12,759 patients and 1966 cardiovascular events and procedures. The subjects had been randomized to receive amlodipine- or atenolol-based therapy. None of them were taking heart rate-liming antihypertensive agents at baseline.

The average reduction in heart rate was greater in the atenolol group than in the amlodipine group: 12.0 vs. 1.3 beats/minute.

Patients treated with amlodipine-based therapy were 19% less likely to experience a cardiovascular event or procedures than were those who received atenolol-based therapy (p < 0.001). Further analysis showed that this benefit was unchanged in patients with higher heart rates. Similar findings, the authors note, were seen regarding the secondary outcomes, nonfatal MI or fatal coronary heart disease and total stroke. “On the basis of considerable evidence, including data in the present study, one can make 2 conclusions: 1) resting heart rate seems to be useless as a guide to choice of antihypertensive therapy; and 2) beta blockers seem to be equally ineffective in reducing CV events in hypertensive patients with tachycardia as in those with bradycardia,” Dr. Carl J. Lavie, from Ochsner Medical Center, New Orleans, and colleagues write in an accompanying editorial. Reference:
J Am Coll Cardiol 2009;54:1154-1161.