What is the appropriate dosage of Atenolol for treating hypertension or angina?

Atenolol Dosage for Hypertension and Angina

For hypertension, the recommended initial dose of atenolol is 50 mg once daily, which can be increased to 100 mg once daily if needed after 1-2 weeks. For angina pectoris, start with 50 mg once daily and increase to 100 mg once daily after one week if optimal response is not achieved, with some patients requiring up to 200 mg once daily 1.

Dosing Guidelines for Hypertension

• Initial dose: 50 mg once daily (either alone or added to diuretic therapy)
• 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 produce further benefit) 1

Atenolol can be used as monotherapy or in combination with other antihypertensive agents including thiazide diuretics, hydralazine, prazosin, and alpha-methyldopa 1.

Dosing Guidelines for Angina Pectoris

• Initial dose: 50 mg once daily
• Dose adjustment: If optimal response not achieved within one week, increase to 100 mg once daily
• Maximum dose: Some patients may require 200 mg once daily for optimal effect 1
• Administration: Once-daily dosing provides 24-hour control 1, 2

Special Populations

Elderly Patients or Patients with Renal Impairment

Atenolol is excreted by the kidneys, so dosage adjustment is necessary in patients with renal impairment 1, 3:

Creatinine Clearance (mL/min/1.73m²)	Maximum Dosage
15-35	50 mg daily
<15	25 mg daily

For elderly hypertensive patients, consider starting with 25 mg once daily 1.

Efficacy and Evidence

• Studies show that once-daily administration of atenolol is therapeutically equivalent to twice-daily administration for hypertension 4.
• For angina, once-daily dosing improves exercise tolerance by 40-74% and extends exercise duration before angina onset by 61-94% 2.
• The largest increase in exercise tolerance for angina was observed with 50 mg once daily, with no major differences between higher doses 2.

Beta-Blocker Selection Considerations

Atenolol is a cardioselective beta-blocker without intrinsic sympathomimetic activity or membrane stabilizing properties 3. According to the American Heart Association, beta-blockers are strongly recommended for secondary prevention in patients with prior myocardial infarction or heart failure 5.

Common Pitfalls and Precautions

• Contraindications: Severe bradycardia, high-grade AV block (without pacemaker), cardiogenic shock, and decompensated heart failure 5.

• Use with caution in patients with:

  • Asthma or COPD (atenolol is preferable to non-selective beta-blockers in these patients due to its cardioselectivity) 3
  • Diabetes mellitus (beta-blockers may mask hypoglycemia symptoms) 5
  • Peripheral arterial disease (rarely made symptomatically worse) 5

• Cessation of therapy: If withdrawal is planned, it should be achieved gradually with patients advised to limit physical activity 1.

• Advantages over other beta-blockers:

  • Lower incidence of central nervous system effects compared to propranolol due to low lipid solubility 3
  • Once-daily dosing improves patient compliance 4

Atenolol's narrow dose response range means highly individualized dose titration is not necessary, making it a practical choice for both hypertension and angina management 3.