Atenolol selective or nonselective
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Atenolol: Selective or Nonselective Beta-Blocker?
Introduction to Beta-Blockers
Beta-blockers are a class of medications commonly used to manage cardiovascular conditions such as hypertension and arrhythmias. They work by blocking the effects of adrenaline on beta receptors, which are found in the heart and other parts of the body. Beta-blockers can be classified into two main categories: selective and nonselective. Selective beta-blockers primarily target beta-1 receptors in the heart, while nonselective beta-blockers affect both beta-1 and beta-2 receptors, which are found in the heart, lungs, and blood vessels.
Atenolol: A Beta-1 Selective Blocker
Atenolol is classified as a beta-1 selective (cardioselective) beta-blocker. This means it primarily targets beta-1 receptors in the heart, which helps to reduce heart rate and blood pressure with minimal impact on beta-2 receptors found in the lungs and blood vessels1 3 6. This selectivity is particularly beneficial for patients with respiratory conditions such as asthma, as it reduces the risk of bronchoconstriction, a common side effect associated with nonselective beta-blockers3.
Comparative Studies: Atenolol vs. Nonselective Beta-Blockers
Hypertension Management
Several studies have compared the efficacy and side effects of atenolol with nonselective beta-blockers in the treatment of hypertension. One study involving long-standing hypertensive patients found that atenolol was effective in lowering systolic and diastolic blood pressure, with fewer side effects such as vivid dreams and muscle cramps compared to nonselective beta-blockers like propranolol, oxprenolol, and pindolol1 7. Additionally, serum creatinine levels were lower in patients taking atenolol, indicating a potentially better renal profile1 7.
Exercise and Training Effects
Research has also explored the impact of beta-blockers on exercise performance and conditioning. Studies have shown that while both selective and nonselective beta-blockers can impair exercise tolerance, the effects are more pronounced with nonselective beta-blockers like propranolol. Atenolol, on the other hand, allows for better exercise performance and conditioning, likely due to its selective action on beta-1 receptors2 4 5.
Glucose Metabolism and Hormonal Responses
The effects of beta-blockers on glucose metabolism and hormonal responses during hypoglycemia have been studied as well. Nonselective beta-blockers like propranolol tend to prolong hypoglycemic episodes and increase glucose uptake in tissues, which can be problematic for diabetic patients. Atenolol, being beta-1 selective, has a lesser impact on glucose metabolism and does not significantly affect free fatty acid concentrations or epinephrine responses during hypoglycemia3.
Vascular Effects
In terms of vascular effects, atenolol and nonselective beta-blockers like carteolol have been compared for their impact on arterial properties. Atenolol tends to decrease blood flow and increase vascular resistance, whereas carteolol, a nonselective beta-blocker, has been shown to decrease vascular resistance and improve blood flow6. This suggests that nonselective beta-blockers may have more favorable effects on peripheral circulation compared to atenolol.
Conclusion
Atenolol is a beta-1 selective beta-blocker, which means it primarily targets beta-1 receptors in the heart, offering advantages in terms of fewer respiratory side effects and better exercise tolerance compared to nonselective beta-blockers. While both types of beta-blockers are effective in managing hypertension, atenolol's selective action makes it a preferable choice for patients with concurrent respiratory conditions or those who require better exercise performance. However, the choice between selective and nonselective beta-blockers should be individualized based on the patient's overall health profile and specific medical needs.
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Most relevant research papers on this topic
Atenolol and three nonselective beta-blockers in hypertension.
Atenolol shows cardioselectivity in treating hypertension, with no significant difference in blood pressure control compared to nonselective beta-blockers.
RCTExercise testing and training with beta-adrenergic blockade: role of the drug washout period in "unmasking" a training effect.
Selective and nonselective beta-blockade therapy both achieve a training effect in exercise, but this effect may not become apparent until the drug is withdrawn.
RCTEffects of nonselective and beta-1-selective blockade on glucose metabolism and hormone responses during insulin-induced hypoglycemia in normal man.
Propranolol and atenolol prolong hypoglycemic responses to insulin by increasing glucose uptake without affecting glucose production, possibly by lowering FFA concentrations.
Non-RCTEffects of selective and nonselective beta-adrenergic blockade on mechanisms of exercise conditioning.
Beta-adrenergic blockade during training affects cardiac and peripheral vascular adaptations, but not skeletal muscle adaptations, suggesting cardioselectivity is not essential for exercise conditioning.
RCTEffects of beta 1-selective and nonselective beta-adrenoceptor blockade during exercise conditioning in healthy adults.
Exercise conditioning can enhance maximal work capacity in healthy adults, but propranolol's fatiguing effects may limit the net improvement in work capacity compared to pretraining state.
RCTComparative long‐term vasoactive effects of atenolol and carteolol on the properties of the small and large arteries of the upper extremities in human essential hypertension
Atenolol reduces blood pressure more effectively than carteolol, but both drugs decrease vascular resistance in the upper extremities.
Non-RCTAtenolol and three nonselective β‐blockers in hypertension
Atenolol shows cardioselectivity in treating hypertension, with no significant difference in blood pressure control compared to nonselective beta blockers.
RCTHemodynamic interaction of nonselective vs. beta‐1‐selective beta‐blockade with hydralazine in normal humans
Propranolol effectively opposes the decrease in afterload induced by hydralazine, while atenolol does not affect this change.
RCTEffect of selective and nonselective beta-adrenoceptor blockade on thermoregulation during prolonged exercise in heat.
Propranolol increases total sweat loss during prolonged exercise in heat, requiring strict fluid-replacement regimens, while atenolol has minimal adverse response.
RCT