My dr. is prescribing 25 mg of Altenol for attacks of

Lisa,

Atenolol is part of a group of drugs called beta blockers. Beta blockers are still one of the recommended drugs in treating conditions like high blood pressure per current guidelines from the American Heart Association. If you have had a previous stroke, Atenolol should be used with caution (but is not contraindicated) due to the possibility of reduced blood flow to the brain in those patients. If you have not had a prior stroke, there are no concerns of Atenolol causing a stroke. I have many patients on Atenolol (it is very commonly used) and none complain of insomnia. Nightmares are considered extremely rare, affecting only about 3% of patients. I would certainly not avoid this drug based on the very low risk of this side effect.

Do you have any additional questions for me? I am happy to help:)

Regards,

Dr. Bridget

If you have the link to the WebMD page, I will take a look at the study they are referring to. We currently do not avoid beta blockers in someone who has no personal history of stroke.

Diuretics are first line for high blood pressure, but will do nothing for tachycardia. As your doctor mentioned, they can make your condition worse by depleting your the blood volume in your body (water loss). Beta blockers or certain types of calcium channel blockers would be the drugs of choice for tachycardia.

At 25 mg, you are on the lowest dose of Atenolol and so discontinuing it is normal practice vs weaning off of it. Higher doses can be weaned due to the possibility of reflex tachycardia, but not at 25 mg/day.

Treadmill is great for increasing heart rate. If you have the heart rate sensors on your machine, you can follow their recommended heart rate guidelines based on your age. My treadmill recommends 110-140 beat per minute for your age.

Thanks for supplying the link. The study is consistent with JNC 8 (the current treatment guidelines for high blood pressure), which continue to recognize thiazide diuretics, calcium channel blockers, ACE inhbitors or ARBs as first line for hypertension. Atenolol and other beta blockers should be considered if first line monontherapy/combo therapy is ineffective. The average blood pressures in the patients in the studies included was 150/87 to 195/102 mmHg...so these results may not apply to someone with outside this range. This study is for high blood pressure only, but having tachycardia is another factor to consider when selecting treatment which would include beta blockers and and calcium channel blockers (verapamil or cardizem only).

The statement about tapering is true, but when you are already on the lowest dose of a drug the accepted way of taking a patient off is to just stop it at that point.

I see...and understand your concerns. Although there is no published data about how much Atenolol can lower the heart rate, clinically I see it drop the rate with varying degrees up to 20 bpm. The medication affects each person differently, so you really wouldn't know exactly what to expect until you have tried it. It is possible to have side effects within the first few days on it, but you may have none. Again, each person is affected differently, but the most commonly reported side effects are dizziness and orthostatic hypotension (low blood pressure upon standing).

As far as the target heart rate, it would be impossible to determine what your target rate should be while on a beta blockers is unless you doctor does a brief exercise stress test (again because beta blockers affect everyone differently the plan must be individualized).

The stroke risk they show is higher for Atenolol, but the studies they selected for the meta analysis almost exclusively included Atenolol vs other beta blockers and non-beta blocker drugs that lower heart rate. So they make it look like Atenolol is the culprit for strokes, when it may not be the drug itself vs having a lower heart rate. There are no current studies or guidelines that suggest we stay away from Atenolol altogether, and so I would be reluctant to say this is a bad drug for all patients. It is also a currently accepted guidelines to use beta blockers like Atenolol when you have both hypertension AND tachycardia.

In the end, you are the one that it taking the medicine, and so you will want to feel confident in what you are putting in your body. There are some other non-beta blocker drugs that can be considered to use for hypertension AND tachycardia (verapamil and diltiazem for example) if you would feel safer staying away from beta blockers.