Is atenolol effective for controlling tachycardia?

From the Guidelines

Atenolol is effective in controlling tachycardia, particularly in patients with atrial fibrillation.

Key Points

• The typical dose for heart rate control ranges from 25 to 100 milligrams per day, administered orally, with the initial dose usually starting at 25-50 milligrams once daily 1.
• Atenolol has been shown to reduce resting heart rate and exercise-induced tachycardia, with optimal effects typically observed within 1-2 weeks of initiation, and its efficacy is maintained with long-term use, often for durations of 6-12 months or more 1.
• Beta blockers, including atenolol, are the most effective drug class for rate control, achieving the specified heart rate endpoints in 70% of patients compared with 54% with use of calcium channel blockers 1.
• Atenolol, metoprolol, and sotalol provide better control of exercise-induced tachycardia than digoxin 1.
• Important considerations for atenolol use include cautious initiation in patients with heart failure and reduced ejection fraction, as well as potential side effects such as hypotension, bradycardia, and heart block 1.

From the FDA Drug Label

In standard animal or human pharmacological tests, beta-adrenoreceptor blocking activity of atenolol has been demonstrated by: (1) reduction in resting and exercise heart rate and cardiac output, (2) reduction of systolic and diastolic blood pressure at rest and on exercise, (3) inhibition of isoproterenol induced tachycardia, and (4) reduction in reflex orthostatic tachycardia A significant beta-blocking effect of atenolol, as measured by reduction of exercise tachycardia, is apparent within one hour following oral administration of a single dose. Consistent with its negative chronotropic effect due to beta blockade of the SA node, atenolol increases sinus cycle length and sinus node recovery time.

Atenolol is effective for controlling tachycardia due to its beta-blocking activity, which has been demonstrated by reduction in resting and exercise heart rate, inhibition of isoproterenol induced tachycardia, and reduction in reflex orthostatic tachycardia 2.

• The beta-blocking effect of atenolol is apparent within one hour following oral administration of a single dose.
• Atenolol increases sinus cycle length and sinus node recovery time, consistent with its negative chronotropic effect.

From the Research

Efficacy of Atenolol in Controlling Tachycardia

• Atenolol is a beta-selective (cardioselective) adrenoceptor blocking drug that has been well studied for its effectiveness in treating hypertension and angina pectoris 3.
• It has a narrow dose response range, which eliminates the need for highly individualized dose titration, and its long duration of beta-blocking activity allows for once daily dosage 3.
• Atenolol has been shown to lower systolic and diastolic blood pressure in people with primary hypertension, with an average reduction of -10/-8 mmHg, and reduce heart rate by 11 beats per minute 4.
• In patients with hyperthyroidism, atenolol has been used to control symptoms such as tachycardia, nervousness, and tremors, and has been shown to reduce resting heart rate by approximately 25 to 30 beats/min 5.
• Atenolol has also been used in pediatric patients with prolonged QT syndrome, and has been shown to be effective in reducing the risk of sudden cardiac death and ventricular arrhythmias 6.
• In patients with heart failure, atenolol has been shown to provide substantial benefits supplementary to high-dose enalapril treatment, including reducing the risk of worsening heart failure and death 7.

Mechanism of Action

• Atenolol works by selectively blocking beta-1 adrenergic receptors in the heart, which reduces heart rate and contractility 3, 4.
• This mechanism of action makes atenolol effective in controlling tachycardia and reducing the risk of sudden cardiac death in patients with prolonged QT syndrome 6.
• Atenolol's cardioselectivity also makes it a useful treatment option for patients with asthma or diabetes mellitus, as it is less likely to cause bronchospasm or hypoglycemia compared to non-selective beta-blockers 3.

Clinical Use

• Atenolol is commonly used to treat hypertension, angina pectoris, and heart failure 3, 4, 7.
• It is also used to control symptoms in patients with hyperthyroidism, such as tachycardia and nervousness 5.
• In pediatric patients with prolonged QT syndrome, atenolol is used to reduce the risk of sudden cardiac death and ventricular arrhythmias 6.