What is the benefit of Atenolol (beta blocker) on blood pressure, given a current reading of normotension, while tapering off a 25 milligram (mg) dose?

From the Guidelines

Tapering off atenolol 25 mg with your current blood pressure of 107/76 is reasonable, but should be done gradually under medical supervision. Your blood pressure is well-controlled, which suggests you might be able to discontinue the medication safely. A typical tapering schedule would involve reducing to 12.5 mg (half tablet) daily for 1-2 weeks, then to 12.5 mg every other day for another 1-2 weeks before stopping completely. This gradual approach helps prevent rebound hypertension or increased heart rate that can occur with abrupt discontinuation. During the tapering process, monitor your blood pressure daily and report readings above 140/90 to your doctor.

Key Considerations

• Beta-blockers like atenolol work by blocking certain adrenaline receptors, reducing heart rate and blood vessel constriction.
• When stopping them, your body needs time to readjust to functioning without this blockade.
• Lifestyle measures like reducing sodium intake, regular exercise, maintaining healthy weight, and stress management become especially important during and after tapering to help maintain your good blood pressure control naturally 1.

Tapering Schedule

• Reduce to 12.5 mg daily for 1-2 weeks
• Then reduce to 12.5 mg every other day for another 1-2 weeks
• Monitor blood pressure daily and report readings above 140/90 to your doctor

Important Reminders

• Always taper off atenolol under medical supervision
• Gradual tapering helps prevent rebound hypertension or increased heart rate
• Lifestyle measures are crucial for maintaining good blood pressure control during and after tapering 1

From the FDA Drug Label

In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy. Some renally-impaired or elderly patients being treated for hypertension may require a lower starting dose of atenolol: 25 mg given as one tablet a day. If this 25 mg dose is used, assessment of efficacy must be made carefully This should include measurement of blood pressure just prior to the next dose (“trough” blood pressure) to ensure that the treatment effect is present for a full 24 hours.

The patient is currently on 25 mg of atenolol with a blood pressure of 107/76. Tapering off atenolol should be done gradually.

• The drug label does not provide a specific tapering schedule for patients with hypertension.
• However, it is recommended that cessation of therapy in patients with angina pectoris should be achieved gradually and patients should be carefully observed and advised to limit physical activity to a minimum 2.
• It is likely that a similar approach should be taken for patients with hypertension.
• The patient's blood pressure should be closely monitored during the tapering process to ensure that it remains under control.

From the Research

Atenolol and Blood Pressure Benefit

• Atenolol is a beta-blocker commonly used to treat hypertension, and its effectiveness in reducing blood pressure has been studied in various trials 3, 4, 5, 6, 7.
• A study published in the Journal of the Indian Medical Association found that atenolol and losartan had similar reductions in systolic and diastolic blood pressure, but atenolol was more effective in converting non-dipper to dipper status 3.
• However, another study published in the Lancet found that atenolol was not as effective as other antihypertensive drugs in reducing cardiovascular morbidity and mortality, and may even be associated with a higher risk of stroke and cardiovascular mortality 7.
• A review of randomized controlled trials published in Expert Opinion on Pharmacotherapy found that beta-blockers, including atenolol, should be used to treat hypertension in specific patient populations, such as those with previous myocardial infarction or congestive heart failure, but may not be the best choice for primary hypertension 4.
• A comparison of atenolol and nebivolol in isolated systolic hypertension found that both drugs had similar effects on brachial blood pressure and aortic stiffness, but nebivolol reduced aortic pulse pressure more than atenolol 6.

Tapering Off Atenolol

• When tapering off atenolol, it is essential to monitor blood pressure closely to avoid rebound hypertension 3, 4.
• A gradual tapering schedule can help minimize the risk of rebound hypertension and other adverse effects 5.
• Patients should be advised to report any changes in their blood pressure or symptoms to their healthcare provider, and to seek medical attention if they experience any severe or persistent side effects 6, 7.

Current Blood Pressure Reading

• A blood pressure reading of 107/76 mmHg is considered within the normal range, and tapering off atenolol may be feasible if the patient's blood pressure remains stable 3, 4.
• However, it is crucial to continue monitoring blood pressure and adjusting the treatment plan as needed to ensure optimal blood pressure control and minimize the risk of cardiovascular complications 5, 6, 7.