What is the recommended dose of Atenolol (beta blocker) for adults with hypertension?

Atenolol Dosing for Hypertension

The recommended initial dose of atenolol for adults with hypertension is 50 mg once daily, which can be increased to a maximum of 100 mg once daily if optimal response is not achieved within 1-2 weeks. 1

Initial Dosing and Titration

• Start with 50 mg once daily (either alone or added to diuretic therapy)
• The full effect of this dose will usually be seen within 1-2 weeks
• If blood pressure control is not achieved, increase to 100 mg once daily
• Increasing beyond 100 mg daily is unlikely to produce additional benefit 1

Monitoring and Follow-up

• Adults initiating atenolol therapy should have follow-up evaluation of adherence and response to treatment at monthly intervals until control is achieved 2
• Blood pressure goal should be less than 130/80 mm Hg for adults with confirmed hypertension 2
• Monitor for bradycardia, hypotension, and other adverse effects during dose titration

Special Populations

Elderly Patients or Patients with Renal Impairment

Atenolol is excreted by the kidneys, so dosage adjustment is required in cases of renal impairment:

• For creatinine clearance 15-35 mL/min/1.73m²: Maximum 50 mg daily
• For creatinine clearance <15 mL/min/1.73m²: Maximum 25 mg daily
• Some elderly patients may require a lower starting dose of 25 mg daily 1

Combination Therapy

• Atenolol may be used alone or with other antihypertensive agents including thiazide-type diuretics, hydralazine, prazosin, and alpha-methyldopa 1
• For stage 2 hypertension (BP ≥140/90 mm Hg), initiation of antihypertensive drug therapy with 2 first-line agents of different classes is recommended 2

Important Cautions and Considerations

• Atenolol should not be used as a first-line agent for uncomplicated hypertension as it is less effective than placebo in reducing cardiovascular events 2
• Beta blockers with intrinsic sympathomimetic activity should be avoided 2
• Do not abruptly discontinue atenolol as this may lead to exacerbation of angina, myocardial infarction, and arrhythmias 3
• Use with caution in patients with diabetes and monitor blood glucose levels 3
• Avoid combining with non-dihydropyridine calcium channel blockers (diltiazem, verapamil) due to risk of bradycardia 3

Evidence on Efficacy

Clinical studies have demonstrated that once-daily administration of atenolol provides effective 24-hour blood pressure control:

• A dose-response study found that 100 mg daily was the optimal dose for treating mild to moderate hypertension, with a mean reduction of 25/16 mmHg in blood pressure 4
• Once-daily dosing of 100 mg atenolol decreases blood pressure throughout the following 24 hours without excessive daily fluctuation in its effects, and without signs of tolerance or accumulation 5

By following these dosing recommendations and monitoring protocols, atenolol can be effectively used as part of hypertension management, though it should be noted that other beta blockers may be preferred in specific clinical scenarios.