From the Guidelines
Atenolol is classified as a beta-blocker, specifically a beta-1 selective adrenergic receptor blocker. It works by blocking the action of adrenaline on beta-1 receptors primarily found in the heart, which reduces heart rate, contractility, and blood pressure. Atenolol is commonly prescribed for conditions such as hypertension (high blood pressure), angina (chest pain), arrhythmias, and as a preventive treatment after heart attacks. The typical dosage ranges from 25 to 100 mg once daily, with 50 mg being a common starting dose for hypertension. Because it is cardioselective, atenolol has fewer effects on beta-2 receptors in the lungs compared to non-selective beta-blockers, making it potentially safer for patients with respiratory conditions. However, it should still be used with caution in patients with asthma or COPD. Patients should not suddenly stop taking atenolol as this can lead to rebound hypertension or worsening of angina symptoms.
According to the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults 1, atenolol is listed as a beta-blocker with a usual dose range of 25-100 mg per day. The guideline also notes that beta blockers are not recommended as first-line agents unless the patient has ischemic heart disease or heart failure.
The choice of beta blocker for an individual patient is based primarily on pharmacokinetic and side effect criteria, as well as on physician familiarity 1. There are no comparative studies between members of this class in the acute setting. Beta blockers without intrinsic sympathomimetic activity are preferred, however. Agents studied in the acute setting include metoprolol, propranolol, and atenolol. Carvedilol may be added to the list of agents studied for post-MI use.
Some key points to consider when prescribing atenolol include:
- Starting with a low dose and titrating up as needed
- Monitoring for signs of hypotension, bradycardia, and heart failure
- Avoiding sudden cessation of the medication
- Using caution in patients with respiratory conditions such as asthma or COPD
- Considering alternative beta blockers in patients with certain comorbidities, such as heart failure or ischemic heart disease.
Overall, atenolol is a commonly used beta blocker that can be effective in managing hypertension, angina, and other cardiovascular conditions. However, it should be used with caution and under the guidance of a healthcare professional.
From the FDA Drug Label
Atenolol is a beta1-selective (cardioselective) beta-adrenergic receptor blocking agent The drug classification of atenolol is a beta blocker.
- Beta1-selective
- Adrenergic receptor blocking agent 2
From the Research
Drug Classification of Atenolol
- Atenolol is a beta-selective (cardioselective) adrenoceptor blocking drug without partial agonist or membrane stabilising activity 3
- It is classified as a beta 1-adrenoceptor antagonist with a duration of activity of at least 24 hours 4
- Atenolol is a type of beta-blocker, which is a mixed group of drugs with diverse pharmacodynamic and pharmacokinetic properties 5
Comparison with Other Beta-Blockers
- Atenolol has been compared to other beta-blockers such as carvedilol, bisoprolol, metoprolol, and nebivolol in various studies 6, 7
- Carvedilol has been shown to significantly reduce all-cause mortality compared to atenolol and other beta 1-selective beta-blockers in patients with heart failure and acute myocardial infarction 6
- Atenolol has been associated with an increased risk of stroke in the elderly compared to nonatenolol beta-blockers and other antihypertensive agents 7
Therapeutic Use
- Atenolol is effective and generally well tolerated in patients with all grades of hypertension, and is also used in the treatment of angina pectoris and other cardiovascular disorders 3, 4
- It is often used as a first-line therapy for hypertension, although its use in this context is controversial due to concerns about its efficacy and safety compared to other antihypertensive agents 5