Atenolol Dosage and Usage for Hypertension
The recommended initial dosage of atenolol for hypertension is 50 mg once daily, which can be increased to 100 mg once daily if optimal response is not achieved after 1-2 weeks. 1
Dosing Guidelines
Standard Dosing
- Initial dose: 50 mg once daily (as a single tablet)
- Full effect: Usually seen within 1-2 weeks
- Dose adjustment: If optimal response not achieved, increase to 100 mg once daily
- Maximum dose: 100 mg daily (increasing beyond this is unlikely to provide additional benefit) 1
Special Populations
For elderly patients or those with renal impairment:
| Creatinine Clearance (mL/min/1.73m²) | Maximum Dosage |
|---|---|
| 15-35 | 50 mg daily |
| <15 | 25 mg daily |
- Some elderly or renally impaired patients may require a lower starting dose of 25 mg once daily 1
- For patients on hemodialysis: 25-50 mg after each dialysis session (under hospital supervision) 1
Administration
- Can be taken with or without food
- Once-daily administration provides 24-hour blood pressure control 2
- Atenolol can be used alone or in combination with other antihypertensive agents, particularly thiazide diuretics 1
Efficacy
- Studies show that 100 mg once daily provides optimal blood pressure reduction for most patients 3
- The magnitude of blood pressure reduction is related to initial systolic blood pressure and degree of inhibition of exercise tachycardia 4
- In clinical trials, 85% of patients achieved blood pressure reductions of more than 20/10 mmHg 4
Monitoring
- Blood pressure should be monitored every 3 months until target is reached
- Follow-up within 1-2 weeks after medication initiation is recommended 5
- For patients on 25 mg dose, measure "trough" blood pressure just before the next dose to ensure 24-hour effectiveness 1
Precautions and Contraindications
Avoid in patients with:
- Asthma or obstructive airway disease
- Decompensated heart failure
- Pre-excited atrial fibrillation or flutter 6
- Bradycardia or heart block
- Cardiogenic shock
Use with caution in:
- Diabetes (may impair glucose tolerance) 4
- Peripheral vascular disease
Discontinuation
If discontinuation is necessary, atenolol should be withdrawn gradually with careful observation and patients should be advised to limit physical activity 1
Side Effects
- Bradycardia
- Hypotension
- Fatigue/tiredness (more common at doses above 100 mg) 3
- Precipitation of heart failure in susceptible patients 6
- Lower incidence of central nervous system effects compared to non-selective beta-blockers 7
Important Considerations
- Beta-blockers are not recommended as first-line agents for hypertension unless the patient has ischemic heart disease or heart failure 6
- Atenolol is a cardioselective (β1-specific) beta-blocker, making it preferable to non-selective beta-blockers in patients with asthma or diabetes 7
- Atenolol is excreted unchanged in urine, requiring dose adjustment in renal impairment 7
Remember that blood pressure management often requires multiple agents to achieve target goals, and atenolol may be combined with other antihypertensive medications, particularly thiazide diuretics, for optimal effect.