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CAT ASCOT Atenolol and NOD
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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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  • 1. CAT: Atenolol and New-Onset Diabetes Mellitus Clinton Pong IM Journal Club 4/2/09
  • 2. 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
  • 3. Search
  • 4. Source ASCOT Trial: CCB (Amlodipine) vs BB (Atenolol)
  • 5. Validity?
    • Randomized
    • Accountable
    • Intention to treat analysis
    • Similar groups
    • Sponsored by Pfizer, Servier, and Leo Pharmaceuticals
  • 6. Population Goal: 18,000 Recruited:19,257 Final study pop: 18,965 Intervention Comparison Amlodipine Atenolol + Perindopril + Bendroflumethiazide (n=9639) (n=9618)
  • 7. 567 799 9072 8819 CV endpoints NOD 5.5 years Amlodipine Atenolol NOD (+) No NOD
  • 8. Results
    • total cardiovascular events and procedures
    • Kaplan-Meier curves of cumulative incidence of new-onset diabetes mellitus
    NNH: 40 NNH: 42
  • 9. 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”
  • 10. 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.
  • 11. 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