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Updating Blood Pressure Treatment



I have high blood pressure with tachycardia and missing heart beats. I am a 49 year old Indian male on Tenormin -100, Norvasc 10 and Cozaar 100 Natrilix SR 1.5. My BP is under control. All my tests are normal though I have LVH and EF 65 %.

The other day I accompanied my elder brother to one internist and casually he asked me about my drugs for blood pressure. According to him, Atenolol is now out of fashion and that I have been taking Tenormin 100 since 1989, he suggested to start Toprol XL 100.

I like to know whether atenolol is now no more in vogue or that one should switch over to Toprol XL 100 as suggested by him ? I like to be enlightened by your views. I shall be obliged to receive your guidance.


Tenormin (atenolol) was introduced in 1976 and has been used as an antihypertensive agent for many years.  It has the advantage of being selective for the heart and to be less prone to aggravate asthma or to cause vasoconstriction in hands and feet.

In several clinical trials, atenolol was less able to reduce cardiovascular events when compared to other drugs, and in some trials it was no more effective than placebo, despite the fact that it lowered blood pressure.

In 2004, a paper was published in the British journal Lancet.  The paper summarized most available trials and came to the conclusion that atenolol may not be a suitable drug for the treatment of hypertension.  In contrast, Toprol XL (but not generic metoprolol) has shown clear benefits in patients with heart failure.  Toprol XL is a long acting beta blocker that is as cardioselective as atenolol. 

Beta blockers are still considered to be an effective class for the treatment of hypertension and/or for heart failure.  Your brother's internist is right that Toprol XL is a better choice than Tenormin.

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Response by:

Max C Reif, MD Max C Reif, MD
Professor of Medicine
Director of Hypertension Section
College of Medicine
University of Cincinnati