Posts Tagged ‘etichs in cardiology’

This was question thrown at me ,  in one of the  patient -physician meet .

“I am a 58 year old business man . I am taking tab Atenolol 50mg for over  6  years .I am comfortable with that .My  BP hovers around 130 /80 mmhg .My heart rate is 64/mt . I have recently  moved to a popular city in south India  . Now , my cardiologist thinks Tablet Atenolol  for hypertension is useless  . . . what do you say sir ?

My answer went on like this  . . . causing much  displeasure  to my  colleagues !

Atenolol  is a  wonder drug for management of both hypertension and angina for more than 2 decades .  It is  still useful in majority of patients with HT .

The reason for  current generation of cardiac physicians   shunning  away  from this drug  is  largely  for  non academic reasons . A drug which is  in market for more than  a decade ,  generally becomes a generic one. Generic drugs are  like  orphan drugs !   and patients  who consume generics are inferior ones .This is how market economics want us to think .

Physicians are sincere followers of  science and science is not sacred ,  often times  . . .  it is the creation  of   corporate gimmicks .

Few small  studies ,  one major publication  , few guideline   from  influential    scientific bodies  , cocktail of   seminars  , symposiums   all that  is required to disseminate  a concept !

The second major reason is every physician wants to behave in unique way . He fears loosing  his prestige and  charm  if  he  continues the same drug prescribed by another physician  . Many patients also do not like to continue the same drug for long time  !

And now a few words for the cardiac scientists !

*The concept of central aortic pressure and beta blocker’s lack of control over it are all concocted .Beta blocker is most powerful agent to reduce the shearing stress in the walls of aorta . We know that and we believe in that and we prescribe it for aortic dissection to attenuate the intimal tear . Can it do this  . . . without lowering central aortic pressure ? Think for a moment !

Atenol and Metoprolol : The curious  companions .

Both being   closely related beta blockers ,  what makes  Atenolol  to be frowned  upon   and  still   Metoprolol  is  alive and kicking  !

 My final answer to your question !

Atenolol is still useful in the management  of HT. If your BP is well controlled ,  and you have no side effects,  there is absolutely no need to change  the drug   . . .  if  you are  insisted  , you may consider  changing  your doctor   . . . . . .  rather !

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