Original InvestigationHypertension and Acid-Base/Electrolyte DisordersKidney Function and Population-Based Outcomes of Initiating Oral Atenolol Versus Metoprolol Tartrate in Older Adults
Section snippets
Design and Setting
We conducted a population-based retrospective matched-cohort study of older adults using linked health care databases in Ontario, Canada, held at the Institute for Clinical Evaluative Sciences. Ontario has approximately 1.8 million adults 65 years or older who have comprehensive health care coverage that includes outpatient drug prescriptions, physician services, and hospitalizations under a single-payer health care system.10 We conducted this study according to a prespecified protocol that was
Study Participants
Cohort selection is presented in Fig S1. We identified 233,272 patients initiated on atenolol (n = 114,706) or metoprolol tartrate treatment (n = 118,566). After matching, we retained 75,257 patients prescribed each of the 2 β-blockers. Baseline characteristics of patients before and after the match are presented in Table 1. Baseline characteristics of the 2 β-blocker groups after matching were nearly identical (standardized differences for 31 characteristics were <6%). The 2 groups were well
Discussion
Patients with lower eGFRs prescribed the oral β-blocker atenolol, which is eliminated by the kidneys, are thought to be prone to adverse events from potential drug accumulation. However, in this observational study, a new outpatient prescription for oral atenolol in elderly patients was not associated with a significantly higher 90-day risk of hospitalization with bradycardia or hypotension compared to metoprolol tartrate. Although these events were more common in patients with lower eGFRs than
Acknowledgements
We thank Brogan Inc, Ottawa, for use of its Drug Product and Therapeutic Class Database.
Support: This project was conducted at the Institute for Clinical Evaluative Sciences (ICES) Western Site. ICES is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). ICES Western is funded by an operating grant from the Academic Medical Organization of Southwestern Ontario. No endorsement by ICES or the Ontario MOHLTC is intended or should be inferred. The opinions,
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