Key result
Sotalol, but not metoprolol or atenolol, was superior to placebo on subjective and objective assessments in 24 patients with essential tremor.
Why the study?
The mode of action of beta-adrenoreceptor antagonists in essential tremor was unclear, necessitating comparison of metoprolol, atenolol, and sotalol efficacy.
Does chronic oral administration of metoprolol, atenolol, or sotalol improve subjective and objective assessments in patients with essential tremor?
RCT (n=24)
double-blind
randomised
Does chronic oral administration of metoprolol, atenolol, or sotalol improve subjective and objective assessments in patients with essential tremor?
Sotalol, but not metoprolol or atenolol, is superior to placebo for essential tremor, suggesting peripheral beta 2-adrenoreceptor mechanisms are predominantly responsible for the beneficial effect of beta-blockers.
Supports sotalol over metoprolol or atenolol for essential tremor; challenges beta-blocker class equivalence in tremor.
In order to elucidate the mode of action of beta-adrenoreceptor antagonists in essential tremor, the efficacy of chronic oral administration of metoprolol, atenolol and sotalol was compared in a randomised, double-blind placebo controlled trial in twenty-four patients. Only sotalol proved superior to placebo on both subjective and "objective" assessments. Metoprolol and sotalol produced comparable degrees of beta-adrenoreceptor antagonism as judged by the blockade of standing tachycardia. Atenolol, in the dose used, produced a trend towards a greater cardiac chronotropic effect. These findings provide no support for the concept that central or peripheral beta 1-adrenoreceptor mechanisms are important in essential tremor. The beneficial effect of beta-adrenoreceptor antagonists may be mediated predominantly through peripheral beta 2-adrenoreceptor mechanisms.
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Leigh et al. (1983) conducted an RCT in essential tremor (n=24). metoprolol, atenolol, and sotalol vs. placebo was evaluated on subjective and objective assessments of tremor. Sotalol, but not metoprolol or atenolol, was superior to placebo on subjective and objective assessments in 24 patients with essential tremor.
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