Atenolol vs lisinopril
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Comparative Analysis of Atenolol vs. Lisinopril in Hypertension Management
Introduction to Atenolol and Lisinopril
Atenolol and lisinopril are commonly prescribed medications for managing hypertension. Atenolol is a beta-blocker, while lisinopril is an angiotensin-converting enzyme (ACE) inhibitor. Both drugs have distinct mechanisms of action and are used to treat various cardiovascular conditions, including hypertension and heart failure.
Blood Pressure Control in Essential Hypertension
Efficacy in Blood Pressure Reduction
Several studies have compared the efficacy of atenolol and lisinopril in reducing blood pressure in patients with mild to moderate essential hypertension. Lisinopril has been shown to produce a greater reduction in systolic blood pressure compared to atenolol 469. Both medications effectively reduce diastolic blood pressure to a similar extent 69. This suggests that while both drugs are effective, lisinopril may offer superior control of systolic blood pressure.
Safety and Tolerability
Both atenolol and lisinopril are generally well-tolerated. However, adverse effects can differ between the two. Lisinopril is associated with a higher incidence of cough, while atenolol may lead to elevated triglycerides 10. Additionally, sexual dysfunction has been reported more frequently with atenolol compared to lisinopril 7.
Cardiovascular Outcomes in Hemodialysis Patients
Left Ventricular Hypertrophy and Cardiovascular Events
In patients undergoing hemodialysis, atenolol-based therapy has been found to be superior to lisinopril-based therapy in preventing cardiovascular morbidity and all-cause hospitalizations 1. Although both drugs improved left ventricular mass index (LVMI) over time, atenolol was associated with fewer serious cardiovascular events and hospitalizations for heart failure 1.
Arterial Stiffness
Atenolol has also been shown to reduce aortic pulse wave velocity more effectively than lisinopril in hemodialysis patients, indicating better improvement in arterial stiffness 5. This effect is primarily attributed to the blood pressure-lowering properties of atenolol.
Kidney Function in Diabetic Nephropathy
Glomerular Filtration Rate and Albuminuria
In hypertensive patients with non-insulin-dependent diabetes mellitus (NIDDM) and diabetic nephropathy, both atenolol and lisinopril effectively slow the decline in kidney function 23. However, lisinopril has a more pronounced effect on reducing urinary albumin excretion, which is a marker of kidney damage 23. This suggests that lisinopril may offer additional renoprotective benefits beyond blood pressure control.
Hemodynamics and Left Ventricular Function
Experimental Mitral Regurgitation
In experimental models of chronic mitral regurgitation, lisinopril significantly reduced preload but had an insignificant effect on left ventricular contractility. Conversely, the addition of atenolol to lisinopril therapy restored left ventricular contractility to normal levels, providing maximum hemodynamic benefit 8.
Conclusion
Both atenolol and lisinopril are effective antihypertensive agents with distinct advantages and limitations. Lisinopril may offer superior systolic blood pressure control and renoprotective effects, while atenolol is more effective in reducing arterial stiffness and preventing cardiovascular events in hemodialysis patients. The choice between these medications should be tailored to the individual patient's clinical profile and specific health needs.
Sources and full results
Most relevant research papers on this topic
Hypertension in hemodialysis patients treated with atenolol or lisinopril: a randomized controlled trial.
Atenolol-based antihypertensive therapy may be superior to lisinopril-based therapy in preventing cardiovascular morbidity and all-cause hospitalizations in maintenance dialysis patients with hypertension and left ventricular hypertrophy.
RCT
Highly CitedLong-Term Effect of Lisinopril and Atenolol on Kidney Function in Hypertensive NIDDM Subjects With Diabetic Nephropathy
Both lisinopril and atenolol effectively reduce kidney function decline in hypertensive NIDDM patients with diabetic nephropathy.
RCTHighly CitedImpact of Lisinopril and Atenolol on Kidney Function in Hypertensive NIDDM Subjects With Diabetic Nephropathy
Lisinopril effectively reduces albuminuria more than atenolol in hypertensive NIDDM patients with diabetic nephropathy, potentially improving kidney function.
RCTHighly CitedComparison of lisinopril versus atenolol for mild to moderate essential hypertension.
Both lisinopril and atenolol effectively reduce blood pressure in essential hypertension patients, with lisinopril showing greater reduction in sitting systolic BP.
RCTEffect of lisinopril and atenolol on aortic stiffness in patients on hemodialysis.
Atenolol is superior in improving arterial stiffness in patients on dialysis, while differences between the two drugs may be due to pleiotropic effects of the drugs.
RCTLisinopril versus atenolol: Decrease in systolic versus diastolic blood pressure with converting enzyme inhibition
Lisinopril effectively reduces systolic blood pressure more effectively than atenolol in treating mild to moderate essential hypertension, possibly due to increased arterial compliance.
RCT
Large Human TrialSexual function in hypertensive males treated with lisinopril or atenolol: a cross-over study.
Atenolol causes a chronic worsening of sexual activity, while lisinopril causes only a temporary decline in sexual activity in hypertensive males.
RCTHighly CitedDifferential effects of the angiotensin-converting enzyme inhibitor lisinopril versus the beta-adrenergic receptor blocker atenolol on hemodynamics and left ventricular contractile function in experimental mitral regurgitation.
Atenolol, when added to lisinopril, effectively improves hemodynamics and restores left ventricular contractility in experimental mitral regurgitation.
Non-RCT
Animal StudyHighly CitedA comparison of lisinopril and atenolol in black and Indian patients with mild-to-moderate essential hypertension.
Lisinopril combined with hydrochlorothiazide effectively lowers blood pressure in both Indian and black patients with mild-to-moderate essential hypertension.
RCTThe Antihypertensive Effect of Lisinopril Compared to Atenolol in Patients with Mild to Moderate Hypertension
Lisinopril effectively reduces sitting systolic blood pressure more effectively than atenolol in patients with mild to moderate hypertension, but both drugs may cause skin rashes and increased triglycerides.
RCTLarge Human Trial