Atenolol

How it works

It selectively blocks beta-1 adrenoceptors in the heart, reducing heart rate, myocardial contractility and conduction velocity, thereby lowering cardiac workload and blood pressure.

Prescribing in practice

• Do not stop abruptly, as sudden withdrawal can precipitate rebound angina, arrhythmia or myocardial infarction, so taper when discontinuing.
• It is renally excreted and accumulates in renal impairment, so dose reduction is needed as function declines.
• Use caution in asthma, peripheral arterial disease and with other rate-limiting drugs, and be aware it may mask signs of hypoglycaemia in diabetes.

Monitoring

Monitor heart rate and blood pressure, and assess renal function as it influences dosing and accumulation.

Counselling the patient

• Do not stop the medicine suddenly without medical advice.
• Report marked dizziness, breathlessness, wheeze or a very slow pulse.
• Be aware it may blunt the usual warning symptoms of low blood sugar if you have diabetes.

Evidence & guidelines

Beta-blockade after myocardial infarction reduces mortality, and NICE positions atenolol within the management of hypertension, angina and arrhythmia.