Clinical evaluation of atenolol in hypertensive patients

Atenolol, a cardioselective beta-adrenergic blocking agent, was given as the sole hypotensive drug for 8-12 weeks to 20 patients with hypertension of varying degrees of severity. Initial systolic blood pressure ranged from 162-238 mm Hg (mean +/- SEM 196 +/- 5.5 mm Hg) and diastolic blood pressure ranged from 105-143 mm Hg (118 +/- 2.5 mm Hg). Three patients had accelerated hypertension, six had cardiomegaly with recent exertional dyspnea and three were diabetics. Atenolol, 100-300 mg once daily, controlled both the supine and standing blood pressure and markedly attenuated the initial hypertensive response to severe exercise. In 17 patients (85%), atenolol therapy reduced blood pressure more than 20/10 mm Hg; however, adequate blood pressure control was not achieved in severe hypertension. A significant hypotensive action developed within 2 weeks of treatment, and control of hypertension was maintained for 2 weeks after sudden interruption of therapy. No patient had postural or postexercise hypotension. The drug appeared to exert its maximum hypotensive effect at the 100-mg dosage. The magnitude of the hypotensive response was related to the initial systolic blood pressure (r = 0.77, p less than 0.01) and the degree of inhibition of exercise tachycardia (r = 0.66, p less than 0.01). The atenolol plasma level and its hypotensive action were not related. Except for impairment of glucose tolerance in diabetic patients, atenolol had minimal side effects.