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Withdrawal of long-term therapy with atenolol in hypertensive patients
Insights
Long-term atenolol therapy cessation showed effects on blood pressure and heart rate that lasted longer than the drug
Area of Science:
- Cardiovascular pharmacology
- Clinical hypertension management
Background:
- Atenolol is a beta-blocker commonly used for hypertension.
- The duration of its therapeutic effects after discontinuation is not fully understood.
Purpose of the Study:
- To investigate the offset of atenolol's effects on blood pressure and heart rate after long-term therapy cessation.
- To compare the offset period with atenolol's elimination half-life.
Main Methods:
- Studied six hypertensive patients undergoing long-term atenolol therapy (200 mg/day).
- Monitored blood pressure and heart rate during withdrawal.
- Analyzed pharmacokinetic profiles after chronic and acute dosing.
Main Results:
- Withdrawal led to a gradual return of blood pressure and heart rate to baseline levels.
- The offset of atenolol's effects significantly exceeded its elimination time.
- No significant pharmacokinetic differences were observed between chronic and acute dosing.
Conclusions:
- Atenolol's effects persist longer than its elimination half-life.
- Unlike propranolol, atenolol withdrawal did not show evidence of rebound hypertension or increased adrenergic sensitivity.
- Caution is advised when discontinuing atenolol in patients with severe coronary artery disease due to unknown mechanisms.
Abstract:
1 The offset of effects on blood pressure and heart rate after cessation of long-term therapy (19 +/- 3.6 months) with atenolol (200 mg once/daily) was studied in six hypertensive patients. 2 Withdrawal of atenolol resulted in a gradual return of lying, standing and post-exercise systolic and diastolic blood pressure levels and heart rate towards the baseline value. The offset of effect greatly exceeded the time for elimination of atenolol. 3 No significant differences in the pharmacokinetic profile of atenolol were evident between the values obtained following chronic dosing and an acute single-dose study. 4 The lack of clinical evidence of increased cardiac adrenergic sensitivity or rebound hypertension following withdrawal of atenolol contrasts with reports of a withdrawal syndrome following cessation of therapy with propranolol. Nevertheless until the mechanism of the propranolol-withdrawal syndrome is better understood caution is required when stopped therapy with atenolol in patients with severe coronary artery disease.