Atenolol

Atenolol is a cardioselective beta-blocker used in a variety of cardiovascular conditions.

Sir James Black, a Scottish pharmacologist, pioneered the use of beta-blockers for the management of angina pectoris in 1958 for which he received the Nobel Prize. Beta-blockers quickly became popular in clinical use and where subsequently investigated for use in myocardial infarction, arrhythmias, and hypertension during the 1960s. Later they continued to be investigated for use in heart failure throughout the 1970-1980s. Atenolol itself was developed early on in this history by Alvogen Malta under the trade name Tenormin and received FDA approval in September, 1981.

Despite being one of the most widely prescribed beta blockers, evidence suggests atenolol may not significantly reduce mortality, and only modestly reduce the risk of cardiovascular disease in patients with hypertension. A Cochrane review of patients being treated for primary hypertension shows that atenolol shows a risk ratio of 0.88 for cardiovascular disease risk and a risk ratio of 0.99 for mortality. Similar results have been found in other meta-analyses. A meta-analysis of over 145,000 patients showed the risk of stroke in patients taking atenolol may depend on the age of the patient. The use of atenolol may need to be based on more patient factors than hypertension alone.

Indicated for:

1) Management of hypertension alone and in combination with other antihypertensives.

2) Management of angina pectoris associated with coronary atherosclerosis.

3) Management of acute myocardial infarction in hemodynamically stable patients with a heart rate greater than 50 beats per minutes and a systolic blood pressure above 100 mmHg.

Off-label uses include:

1) Secondary prevention of myocardial infarction.

2) Management of heart failure.

3) Management of atrial fibrillation.

4) Management of supraventricular tachycardia.

5) Management of ventricular arrythmias such as congenital long-QT and arrhythmogenic right ventricular cardiomyopathy.

6) Management of symptomatic thyrotoxicosis in combination with methimazole.

7) Prophylaxis of migraine headaches.

8) Management of alcohol withdrawal.