Atenolol Dosing for Hypertension and Angina
For adults with hypertension or angina, atenolol should be initiated at 50 mg once daily, with potential increase to 100 mg once daily if needed after 1-2 weeks, but it should not be used as first-line therapy due to being less effective than placebo in reducing cardiovascular events. 1, 2
Dosing Algorithm for Hypertension
- Initial dose: 50 mg once daily (oral tablet) 2
- Full effect typically seen within 1-2 weeks 2
- If optimal response not achieved after 1-2 weeks, increase to 100 mg once daily 2
- Doses beyond 100 mg daily are unlikely to produce additional benefit for hypertension 2
- May be used alone or with other antihypertensive agents (thiazide diuretics, hydralazine, prazosin, alpha-methyldopa) 2
Dosing Algorithm for Angina Pectoris
- Initial dose: 50 mg once daily (oral tablet) 2
- If optimal response 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
- The maximum early effect on exercise tolerance occurs with doses of 50-100 mg, but at these doses the 24-hour effect is reduced to 50-75% of that observed with 200 mg daily 2, 3
Important Considerations and Warnings
- Atenolol should not be used as first-line therapy for hypertension as it is less effective than placebo in reducing cardiovascular events 1
- Preferred beta blockers for hypertension include carvedilol, metoprolol succinate, and bisoprolol 1
- For stable ischemic heart disease with angina, other beta blockers are preferred over atenolol 1
- Once-daily administration provides 24-hour blood pressure control in most patients 4
Dosing in Special Populations
- Elderly patients: Start at the lower end of dosing range (25-50 mg daily) 2
- Renal impairment: Dose adjustment required based on creatinine clearance 2:
- Creatinine clearance 15-35 mL/min/1.73m²: Maximum 50 mg daily
- Creatinine clearance <15 mL/min/1.73m²: Maximum 25 mg daily
- Hemodialysis patients: 25 mg or 50 mg after each dialysis session (under hospital supervision) 2
Combination Therapy
- May be combined with dihydropyridine calcium channel blockers for persistent hypertension and angina 1
- For stable ischemic heart disease, ACE inhibitors or ARBs may be added if blood pressure goal is not met 1
- Fixed combination with nifedipine has shown efficacy at lower doses than monotherapy 5
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
- If discontinuing in patients with angina, withdraw gradually to minimize risk 2