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CAT ASCOT Atenolol and NOD
 

CAT ASCOT Atenolol and NOD

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My First Practice-Altering CAT. And I'm not even in practice yet!

My First Practice-Altering CAT. And I'm not even in practice yet!

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    CAT ASCOT Atenolol and NOD CAT ASCOT Atenolol and NOD Presentation Transcript

    • CAT: Atenolol and New-Onset Diabetes Mellitus Clinton Pong IM Journal Club 4/2/09
    • My Clinical Question
      • “ Is Atenolol associated with new-onset diabetes mellitus (NOD) in patients with significant cardiovascular risk factors?
      • “ CV RF”
        • 55+ y/o
        • Male
        • smoker
        • LVH
        • EKG abnormalities
        • DM II
        • PAD
        • PMH Stroke/TIA
        • Microalbuminuria/proteinuria
        • Tchol:HDL >6
        • FHx of premature CHD
    • Search
    • Source ASCOT Trial: CCB (Amlodipine) vs BB (Atenolol)
    • Validity?
      • Randomized
      • Accountable
      • Intention to treat analysis
      • Similar groups
      • Sponsored by Pfizer, Servier, and Leo Pharmaceuticals
    • Population Goal: 18,000 Recruited:19,257 Final study pop: 18,965 Intervention Comparison Amlodipine Atenolol + Perindopril + Bendroflumethiazide (n=9639) (n=9618)
    • 567 799 9072 8819 CV endpoints NOD 5.5 years Amlodipine Atenolol NOD (+) No NOD
    • Results
      • total cardiovascular events and procedures
      • Kaplan-Meier curves of cumulative incidence of new-onset diabetes mellitus
      NNH: 40 NNH: 42
    • Care of my patient
      • Atenolol’s effectiveness in the prevention of CV disease has been called into question by numerous other studies
      • No long-term comparative effectiveness studies compare it to other beta blockers
      • Regarded as an “atypical beta blocker”
    • Summary statement:
      • I do believe that the results suggest that Atenolol is an inferior choice for the initial treatment of HTN in the prevention of CV disease and new-onset diabetes compared to Amlodipine and I recommend that our patients switch to this drug today.
    • Resources
      • Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendroflumethiazide as required, in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA): a multicentre randomised controlled trial.
        • Dahlöf B, et al. Lancet. 2005 Sep 10-16;366(9489):895-906.
      • The Anglo-Scandinavian Cardiac Outcomes Trial-- blood pressure lowering arm. (ASCOT)
        • J Clin Pharm Ther. 2006 Aug;31(4):299-307