What is the recommended dose and frequency of Atenolol (beta-blocker) for adults with hypertension or angina?

Atenolol Dosage and Frequency for Hypertension and Angina

For adults with hypertension, atenolol should be initiated at 50 mg once daily, with potential increase to 100 mg once daily if needed, but should not be used as first-line therapy due to being less effective than placebo in reducing cardiovascular events. 1, 2

Dosing for Hypertension

• Initial dose: 50 mg once daily (as a single tablet), with full effect typically seen within 1-2 weeks 2
• If optimal response is not achieved after 1-2 weeks, increase to 100 mg once daily 2
• Doses beyond 100 mg daily are unlikely to produce additional benefit 2
• Once-daily administration provides 24-hour blood pressure control, improving compliance compared to twice-daily regimens 3

Dosing for Angina Pectoris

• Initial dose: 50 mg once daily 2
• If optimal response is not achieved within one week, increase to 100 mg once daily 2
• Some patients may require up to 200 mg once daily for optimal effect 2
• For stable ischemic heart disease with angina, other beta blockers are preferred over atenolol 1

Important Warnings and Contraindications

• Atenolol should not be used as first-line therapy for hypertension as it is less effective than placebo in reducing cardiovascular events 1, 4
• Preferred beta blockers for hypertension include carvedilol, metoprolol succinate, and bisoprolol 4
• Avoid in patients with asthma, obstructive airway disease, decompensated heart failure, and pre-excited atrial fibrillation or flutter 1
• Use with caution in patients with diabetes as it may impair glucose tolerance 5

Special Populations

• Renal impairment: Dosage adjustment required as atenolol is excreted by the kidneys 2
  • Creatinine clearance 15-35 mL/min/1.73m²: Maximum 50 mg daily 2
  • Creatinine clearance <15 mL/min/1.73m²: Maximum 25 mg daily 2
• Elderly patients: Start at the lower end of dosing range (25 mg daily), with careful assessment of efficacy 2
• Hemodialysis patients: 25 mg or 50 mg after each dialysis session under hospital supervision 2

Combination Therapy

• May be used with dihydropyridine calcium channel blockers for patients with persistent hypertension and angina 1
• Can be combined with thiazide-type diuretics, hydralazine, prazosin, and alpha-methyldopa for enhanced blood pressure control 2
• For patients with stable ischemic heart disease, ACE inhibitors or ARBs may be added if blood pressure goal is not met 1

Monitoring

• Monitor heart rate, blood pressure, and ECG when initiating therapy 1
• Target blood pressure for patients with stable ischemic heart disease should be less than 130/80 mm Hg 1
• Assess for side effects including bradycardia, hypotension, and worsening heart failure 1

Clinical Efficacy

• Atenolol 100 mg once daily provides significant blood pressure reduction that lasts for 24 hours 3
• The magnitude of hypotensive response is related to initial systolic blood pressure and degree of inhibition of exercise tachycardia 5
• Once-daily dosing is therapeutically equivalent to twice-daily dosing, potentially improving patient compliance 6