Useful Links - these seem good but everybody plays with data and statistics so be smart and vigilant

Hi Brian: Thanks for your comment - first off, I don't believe we "denounced" beta-blockers but rather stated the evidence wasn't as convincing for this class of drugs compared to others. I had seen this meta-analysis and it really didn't change my conclusion on atenolol or beta-blockers in general. Here is my reasoning and it is based on looking at the actual data rather than the "true experts" interpretation.

1) in regard to atenolol the authors state “The relative risk estimate from a previous analysis of four blood pressure difference trials of atenolol of 0.99 (95% confidence interval 0.83 to 1.19) was revised to 0.93 (0.75 to 1.14) in our analysis with the inclusion of two additional atenolol trials”.
So what we have are two studies added to the four from a previous analysis that we reported on and still atenolol has yet to show a statistical reduction in clinical endpoints - the risk estimate (0.75 to 1.14) clearly includes 1. Based on this, I still conclude atenolol, despite the fact it lowers blood pressure, has not been shown to reduce cardiovascular events. Other drugs HAVE shown a benefit in reducing cardiovascular events.
2) in regard to other beta-blockers, these authors, in contrast to other published meta-analyses, included trials which would be considered more like secondary prevention trials as many patients had a history of CHD – this could have an impact on the outcome. Nonetheless, figure 1 shows beta-blockers as the only class of drugs not showing a statistical reduction in CHD (although the upper end of the confidence interval is just 1.02). In addition, compared to calcium channel blockers and diuretics, stroke reduction was close to being statistically different in favour of these two agents over beta-blockers and in fact in figure 3, betablockers versus all other agents were statistically inferior when it came to stroke reduction.
Based on the above, I still think the evidence for reducing CVD events is general weaker for beta-blockers than for other drugs, and we still have no evidence that atenolol reduces CVD events. But clearly data interpretation is in the eye of the beholder and I would be more than happy to hear how you would interpret this evidence.

Hope this helps and thanks for listening to our podcast.