What is the recommended usage and dosage of atenolol (beta-blocker) for patients with hypertension or coronary heart disease?

Atenolol Usage and Dosing for Hypertension and Coronary Heart Disease

For patients with hypertension, the recommended initial dose of atenolol 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 for Hypertension

• Initial dose: 50 mg once daily, either alone or added to diuretic therapy 1
• Full effect typically seen within 1-2 weeks 1
• If optimal response not achieved, increase to 100 mg once daily 1
• Doses beyond 100 mg daily are unlikely to provide additional benefit 1, 2
• In some patients, maximal blood pressure reduction can be achieved with just 50 mg daily 3
• The magnitude of hypotensive response is related to initial systolic blood pressure and degree of inhibition of exercise tachycardia 4

Dosing for Coronary Heart Disease (Angina Pectoris)

• Initial dose: 50 mg once daily 1
• If optimal response not achieved within one week, increase to 100 mg once daily 1
• Some patients may require up to 200 mg once daily for optimal effect 1
• Twenty-four hour control is achieved with once-daily dosing 1

Special Populations

• Elderly patients or those with renal impairment may require lower doses 1:
  • For creatinine clearance 15-35 mL/min/1.73m²: Maximum 50 mg daily 1
  • For creatinine clearance <15 mL/min/1.73m²: Maximum 25 mg daily 1
• Some elderly hypertensive patients may require a lower starting dose of 25 mg once daily 1
• Patients on hemodialysis should be given 25 mg or 50 mg after each dialysis under hospital supervision 1

Acute Myocardial Infarction Protocol

• Treatment should be initiated as soon as possible after hospital arrival 1
• Begin with IV administration of 5 mg over 5 minutes followed by another 5 mg IV injection 10 minutes later 1
• For patients who tolerate the full IV dose (10 mg), initiate oral atenolol 50 mg 10 minutes after the last IV dose 1
• Follow with another 50 mg oral dose 12 hours later 1
• Continue with 100 mg once daily or 50 mg twice daily for 6-9 days or until hospital discharge 1

Contraindications and Precautions

• Avoid in patients with 5:
  • Heart failure or signs of low cardiac output
  • Marked first-degree AV block (PR interval >0.24 seconds)
  • Second or third-degree heart block without a functioning pacemaker
  • Asthma or reactive airway disease
  • Hypotension (systolic BP <90 mm Hg)
  • Significant sinus bradycardia (heart rate <50 beats/minute)
• Use cautiously in patients with diabetes as it may impair glucose tolerance 4

Combination Therapy

• Atenolol may be used alone or with other antihypertensive agents 1
• Common combinations include:
  • Thiazide or thiazide-type diuretics 1
  • Hydralazine 1
  • Prazosin 1
  • Alpha-methyldopa 1
• Avoid combination with non-dihydropyridine calcium channel blockers (verapamil, diltiazem) in patients with heart failure 5

Discontinuation

• If withdrawal is planned, it should be achieved gradually 1
• Patients should be advised to limit physical activity during withdrawal 1
• Abrupt cessation should be avoided to prevent rebound hypertension or worsening of angina 5

Efficacy Considerations

• Once-daily administration provides therapeutic equivalence to twice-daily dosing, which may improve patient compliance 6
• Alpha blockers like doxazosin may be more effective than atenolol in reducing overall coronary artery disease risk due to more favorable effects on HDL cholesterol 7
• In patients with heart failure and reduced ejection fraction, carvedilol, metoprolol succinate, bisoprolol, or nebivolol are preferred over atenolol 5

Monitoring

• Blood pressure should be measured just prior to the next dose to ensure full 24-hour coverage 1
• Monitor for signs of worsening heart failure, bronchospasm, or hypotension 5
• For patients with diabetes, monitor glucose tolerance 4