Eight RCTs (n=23,394) were included in the review.
Atenolol compared with placebo or no treatment (4 RCTs, n=6,825).
No significant difference was found on all-cause mortality (RR 1.01, 95% CI: 0.89, 1.15), cardiovascular mortality (RR 0.99, 95% CI: 0.83, 1.18), or myocardial infarction (RR 0.99, 95% CI: 0.83, 1.19). The risk of stroke was lower in patients given atenolol than those given placebo, although this was not statistically significant (RR 0.85, 95% CI: 0.72, 1.01). No evidence of statistical heterogeneity was found for any outcome.
The mean BP (systolic/diastolic) changes were -4.0/-3.0, -5.8/-2.9, -13.5/-7 and -18/-11.0 mmHg.
Atenolol compared with other antihypertensive treatments (5 RCTs, n=17,671). Atenolol was associated with a significant increase in the risk of all-cause mortality (RR 1.13, 95% CI: 1.02, 1.25) and stroke (RR 1.30, 95% CI: 1.12, 1.5). No evidence of statistical heterogeneity was found (P=0.49 and P=0.63, respectively).
The risk of cardiovascular mortality was also slightly higher in those given atenolol (RR 1.16, 95% CI: 1.00, 1.34), but there was no significant difference in the risk of myocardial infarction (RR 1.04, 95% CI: 0.89, 1.2). There was evidence of statistical heterogeneity for both these outcomes (P=0.08 and P=0.03, respectively).
The mean BP (systolic/diastolic) changes were 0/-1, -1.0/0.5, -1.0/-1.0, 1.1/0.2 and -0.2/-0.1 mmHg.
The sensitivity analysis revealed that the conclusions did not differ when the large RCT was not included in the meta-analysis.