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lüll Atenolol is associated with lower day-of-surgery heart rate compared to long- and short-acting metoprolol Schonberger RB; Brandt C; Feinleib J; Dai F; Burg MMJ Cardiothorac Vasc Anesth 2013[Apr]; 27 (2): 298-304OBJECTIVES: The authors analyzed the association between outpatient beta-blocker type and day-of-surgery (DOS) heart rate in ambulatory surgical patients. They further investigated whether differences in DOS heart rate between atenolol and metoprolol could be explained by once-daily versus twice-daily dosing regimens. DESIGN: Retrospective observational study. SETTING: Veterans Administration hospital. PARTICIPANTS: Ambulatory surgical patients on long-term atenolol or metoprolol. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Using a propensity-score-matched cohort, DOS heart rates were compared in patients prescribed atenolol versus metoprolol. Then, once-daily and twice-daily metoprolol formulations were differentiated and DOS heart rates were compared within a general linear model. DOS heart rates in patients prescribed atenolol versus any metoprolol formulation were slower by a mean of 5.1 beats/min (66.6 v 71.7; 95% confidence interval [CI] of difference, 1.9-8.3; p = 0.002), a difference that was not observed in preoperative primary care visits. The general linear model showed that patients prescribed atenolol (typically once-daily dosing) had a mean DOS heart rate 5.6 beats/min lower compared with patients prescribed once-daily metoprolol succinate (68.9 v 74.5; 95% CI of difference, -8.6 to -2.6; p < 0.001) and 3.8 beats/min lower compared with patients prescribed twice-daily metoprolol tartrate (68.9 v 72.7; 95% CI of difference, -6.1 to -1.6; p < 0.001). DOS heart rates were similar between different formulations of metoprolol (95% CI of difference, -1.0 to +4.6; p = 0.22). CONCLUSIONS: Atenolol is associated with a lower DOS heart rate versus metoprolol. The heart rate difference is specific to the day of surgery and is not explained by once-daily versus twice-daily dosing regimens.|Adrenergic beta-Antagonists/administration & dosage/*therapeutic use[MESH]|Aged[MESH]|Ambulatory Surgical Procedures[MESH]|Antihypertensive Agents/administration & dosage/therapeutic use[MESH]|Atenolol/administration & dosage/*therapeutic use[MESH]|Chemistry, Pharmaceutical[MESH]|Cohort Studies[MESH]|Confidence Intervals[MESH]|Delayed-Action Preparations[MESH]|Female[MESH]|Heart Rate/*drug effects[MESH]|Hemodynamics/drug effects[MESH]|Humans[MESH]|Least-Squares Analysis[MESH]|Linear Models[MESH]|Male[MESH]|Metoprolol/administration & dosage/*therapeutic use[MESH]|Middle Aged[MESH]|Outpatients[MESH]|Patient Compliance[MESH]|Propensity Score[MESH]|Treatment Outcome[MESH] |