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BMJ (Clinical Research Ed.) Sep 1990To determine the effect of atenolol on the outcome of pregnancy in women with essential hypertension. (Clinical Trial)
Clinical Trial Randomized Controlled Trial
OBJECTIVE
To determine the effect of atenolol on the outcome of pregnancy in women with essential hypertension.
DESIGN
Prospective, randomised, double blind, placebo controlled study.
SETTING
Hospital clinic.
PATIENTS
33 Women with mild essential hypertension (systolic blood pressure 140-170 mm Hg or diastolic pressure 90-110 mm Hg on two occasions at least 24 hours apart) consecutively referred to two obstetric medical clinics. Four patients in the placebo group were withdrawn from the study: control of blood pressure was inadequate in two, one developed breathlessness, and one changed her mind about participating. The mean gestation in the 29 remaining women on entry to the study was 15.9 weeks.
MAIN OUTCOME MEASURES
Blood pressure and birth weight.
INTERVENTION
14 Women received placebo. 15 Women received atenolol 50 mg daily initially, increasing until either the blood pressure was less than 140/90 mm Hg or a dose of 200 micrograms daily was reached.
RESULTS
The mean blood pressure on entry was 148/86 mm Hg in the group given atenolol and 144/86 mm Hg in the group given placebo. During treatment the mean diastolic pressure was significantly reduced by atenolol compared with placebo (to 74 v 81 mm Hg; difference in means (95% confidence interval) 7.0 (2.9 to 10.0) mm Hg) but the effect on systolic pressure was marginal (132 v 136 mm Hg; 4.0 (-1.4 to 8.6) mm Hg). Babies in the atenolol group had a significantly lower birth weight than those in the placebo group (2620 g v 3530 g; 910 (440 to 1380)g).
CONCLUSION
Atenolol given from the end of the first trimester in patients with mild hypertension is associated with intrauterine growth retardation. When taken in conjunction with the results of a previous study in which methyldopa was given these findings indicate that benefit is unlikely to result from treating mild essential hypertension in pregnancy.
Topics: Atenolol; Birth Weight; Blood Pressure; Double-Blind Method; Female; Fetal Growth Retardation; Gestational Age; Humans; Hypertension; Infant, Newborn; Pregnancy; Pregnancy Complications, Cardiovascular; Prognosis; Prospective Studies
PubMed: 2242456
DOI: 10.1136/bmj.301.6752.587 -
Xenobiotica; the Fate of Foreign... May 19781. The disposition and metabolism of 1-(4-carbamoyl[14C]methylphenoxy)-3-isopropylaminopan-2-ol (atenolol, Tenormin) has been studied in man following oral and...
1. The disposition and metabolism of 1-(4-carbamoyl[14C]methylphenoxy)-3-isopropylaminopan-2-ol (atenolol, Tenormin) has been studied in man following oral and intravenous doses. 2. Approx. 50% of an oral dose was eliminated in urine; the major radiolabelled component was atenolol (approx. 90%). Faecal extracts also contained largely unchanged atenolol, with small amounts of more polar metabolites. Biliary excretion of atenolol and its metabolites is not a major route of elimination in man. Metabolism of the compound is not extensive and route-dependent modes of metabolism do not appear to complicate the position. 3. Atenolol appeared to be the only major radiolabelled component in blood. 4. Oral doses of atenolol are incompletely absorbed (range 46-62%), even when formulated as a solution. 5. 1-[4-(C-Carbamoylhydroxymethyl)phenoxy]-3-isopropylaminopropan-2-ol was a minor urinary metabolite, which has only one tenth the activity of the parent compound as a beta-adrenergic blocking agent in the rat. 6. Pharmacological activity in man appears to be due to atenolol alone.
Topics: Administration, Oral; Aged; Atenolol; Feces; Humans; Hydrogen-Ion Concentration; Injections, Intravenous; Male; Middle Aged; Propanolamines; Time Factors
PubMed: 27019
DOI: 10.3109/00498257809060956 -
British Journal of Clinical Pharmacology Nov 2010This study was conducted to determine whether atenolol was able to decrease BP level and mitigate BP increase during dynamic resistance exercise performed at three...
AIMS
This study was conducted to determine whether atenolol was able to decrease BP level and mitigate BP increase during dynamic resistance exercise performed at three different intensities in hypertensives.
METHODS
Ten essential hypertensives (systolic/diastolic BP between 140/90 and 160/105mmHg) were blindly studied after 6 weeks of placebo and atenolol. In each phase, volunteers executed, in a random order, three protocols of knee-extension exercises to fatigue: (i) one set at 100% of 1RM; (ii) three sets at 80% of 1RM; and (iii) three sets at 40% of 1RM. Intra-arterial radial blood pressure was measured throughout the protocols.
RESULTS
Atenolol decreased systolic BP maximum values achieved during the three exercise protocols (100% = 186 ± 4 vs. 215 ± 7, 80% = 224 ± 7 vs. 247 ± 9 and 40% = 223 ± 7 vs. 252 ± 16mmHg, P < 0.05). Atenolol also mitigated an increase in systolic BP in the first set of exercises (100% =+38 ± 5 vs.+54 ± 9; 80% =+68 ± 11 vs. +84 ± 13 and 40% =+69 ± 7 vs.+84 ± 14, mmHg, P < 0.05). Atenolol decreased diastolic BP values and mitigated its increase during exercise performed at 100% of 1RM (126 ± 6 vs. 145 ± 6 and +41 ± 6 vs.+52 ± 6, mmHg, P < 0.05), but not at the other exercise intensities.
CONCLUSIONS
Atenolol was effective in both reducing systolic BP maximum values and mitigating BP increase during resistance exercise performed at different intensities in hypertensive subjects.
Topics: Adult; Antihypertensive Agents; Atenolol; Blood Pressure; Exercise; Female; Humans; Hypertension; Male; Middle Aged; Resistance Training
PubMed: 21039760
DOI: 10.1111/j.1365-2125.2010.03742.x -
British Journal of Clinical Pharmacology Nov 19811 The pharmacological properties of atenolol suggest its possible usefulness in pregnancy-induced hypertension. The pharmacokinetics of atenolol in the pregnant woman,...
1 The pharmacological properties of atenolol suggest its possible usefulness in pregnancy-induced hypertension. The pharmacokinetics of atenolol in the pregnant woman, concentrations in cord blood, and its effects on maternal blood pressure and the foetus, are evaluated. 2 We studied 13 pregnant women with hypertension, most of them uncontrolled on methyldopa. Whole blood concentrations and urinary excretion of the drug were measured over 24 h following a 100 mg dose. Effects on maternal blood pressure, pulse rate and foetal heart rate and cardiotocograph were compared for the 4 days before treatment and the first 4 days of treatment. The birth weights and Apgar scores of the babies were recorded. 2 The pharmacokinetics of atenolol (plasma half-life of about 8 h) in pregnant women do not differ from the findings in the non-pregnant. The levels of atenolol in the cord blood were confirmed as approximately equal to those in the maternal blood. 4 In the ten women in whom blood pressure was assessed a small significant fall in blood pressure was observed. 5 A 5% mean fall in foetal heart rate resulted but in one case was a rate below 120 beats/min recorded. There was no evidence of depression of the stress response of the foetal heart. Apgar scores 5 min post partum were satisfactory. 6 Atenolol appears to be safe for use in hypertensive pregnancies. Its effectiveness as an antihypertensive agent in pregnancy requires further controlled evaluation.
Topics: Adult; Atenolol; Female; Fetus; Humans; Hypertension; Kinetics; Pregnancy; Pregnancy Complications, Cardiovascular; Propanolamines
PubMed: 7332738
DOI: 10.1111/j.1365-2125.1981.tb01296.x -
International Journal of Clinical... Oct 1987In healthy volunteers (n = 8), the biological equivalence of the two oral atenolol preparations was investigated. Atenolol concentration was assessed by HPLC. Drug and... (Comparative Study)
Comparative Study Review
In healthy volunteers (n = 8), the biological equivalence of the two oral atenolol preparations was investigated. Atenolol concentration was assessed by HPLC. Drug and internal standard were isolated by adsorption with active charcoal. Chromatography was performed on RP-18 column (10 mu) with mobile phase of 0.015 mol/l KH2PO4/acetonitrile 70:30. The flow rate of the mobile phase was 1.5 ml/min. UV detector operated at the wave length of 225 nm. The sensitivity of the method was 25 micrograms/l and variation coefficients within the assay were less than 10% in the therapeutic concentration range. Biological half-life was on the average 3.8 h, absorption half-life 0.8 h, and the peak concentration time 2.5 h. Both preparations have been found bioequivalent.
Topics: Administration, Oral; Adult; Atenolol; Biological Availability; Chromatography, High Pressure Liquid; Half-Life; Humans; Relative Biological Effectiveness
PubMed: 3323073
DOI: No ID Found -
Annals of Internal Medicine Apr 1992To compare the effects of atenolol and nifedipine on mood and cognitive function in elderly hypertensive patients. (Clinical Trial)
Clinical Trial Comparative Study Randomized Controlled Trial
OBJECTIVE
To compare the effects of atenolol and nifedipine on mood and cognitive function in elderly hypertensive patients.
DESIGN
Randomized, double-blind, crossover trial.
PATIENTS
Thirty-one elderly volunteers (7 women and 4 men) 60 to 81 years of age with mild to moderate hypertension were recruited from the general community and a Veterans Affairs hospital hypertension clinic. Six volunteers withdrew at early phases of the study for reasons unrelated to adverse drug effects.
INTERVENTIONS
Participants had 2 weeks of placebo, to 6 weeks of titration with atenolol or nifedipine, and weeks of treatment followed by similar periods with the other drug.
MEASUREMENTS
Psychometric tests designed to assess mood and cognitive function.
RESULTS
In the group first treated with nifedipine, the summed recall score on the Buschke selective reminding test (a test of verbal learning and memory) decreased by 9.3 words (95% CI, 2.8 to 15.6 words), or 0%, during nifedipine treatment compared with placebo (P = 0.031). The group first treated with atenolol showed no improvement in summed recall scores when results seen during atenolol therapy and placebo administration were compared (P = 0.10); however, this group had an improvement of 16.1 words (CI, 5.6 to 26.5 words), or of 16%, when the atenolol score was compared with the nifedipine score (P = 0.026). In the group first treated with nifedipine, 6 of 11 patients 55%) showed a decrease of 5 words or more during nifedipine therapy compared with placebo, whereas only 1 of the 14 patients (7%) in the group first treated with atenolol showed a similar decrease (P less than 0.01). On the digit symbol test (a psychomotor test), patients treated first with atenolol tended to improve, whereas patients treated first with nifedipine tended to decline. The difference between nifedipine and atenolol, in terms of the change from the score seen during placebo, was 4.3 codings (CI, 0.7 to 7.9 codings) or 10% (P = 0.043). No statistically significant differences were seen between nifedipine and atenolol therapy regarding the other measures of psychomotor ability, sustained attention, motor performance, verbal fluency, or abstract reasoning, and no effects of either drug on mood or psychopathologic symptoms were noted.
CONCLUSIONS
Although atenolol and nifedipine are generally free of gross effects on cognition or mood, nifedipine may subtly impair learning and memory in some elderly hypertensive patients.
Topics: Affect; Aged; Aged, 80 and over; Atenolol; Cognition; Double-Blind Method; Female; Humans; Hypertension; Male; Memory; Middle Aged; Nifedipine; Prospective Studies
PubMed: 1546860
DOI: 10.7326/0003-4819-116-8-615 -
American Journal of Hypertension Jun 1999Atenolol use may be associated with growth retardation when given in pregnancy, although the relationship to trimester of initiation, duration of treatment, and its use... (Clinical Trial)
Clinical Trial
Atenolol use may be associated with growth retardation when given in pregnancy, although the relationship to trimester of initiation, duration of treatment, and its use as monotherapy is still uncertain. To compare the obstetric and fetal outcome between women receiving atenolol (as monotherapy) and other antihypertensive drug monotherapies, and also to investigate the effect of duration of treatment on fetal growth, we performed a retrospective cohort study of 312 pregnancies in 223 women attending an Antenatal Hypertension Clinic. Atenolol (as monotherapy) was given in 78 pregnancies (25.0%), other types of antihypertensive drugs as monotherapy were given in 53 pregnancies (17.0%), and multiple drug combinations were given in 90 pregnancies (28.8%). In 91 pregnancies (29.2%) no antihypertensive drugs were given. Atenolol was found to be associated with lower birth weight and ponderal index values, with a trend toward a higher prevalence of preterm (<37 weeks) delivery and small-for-gestational-age babies when compared to other antihypertensive drugs as monotherapy, or to no treatment. The adverse effect of atenolol was more pronounced in women receiving the drug earlier in their pregnancy, and continuing the drug for a longer duration. In conclusion, atenolol should be avoided in the early stages of pregnancy and given with caution at the later stages, as it is associated with fetal growth retardation, which is related to duration of treatment.
Topics: Adult; Antihypertensive Agents; Atenolol; Embryonic and Fetal Development; Female; Humans; Hypertension; Infant, Newborn; Pregnancy; Pregnancy Complications, Cardiovascular; Pregnancy Outcome; Retrospective Studies
PubMed: 10371362
DOI: 10.1016/s0895-7061(99)00031-x -
British Journal of Clinical Pharmacology Feb 1982
Comparative Study
Topics: Administration, Oral; Adult; Aged; Aging; Atenolol; Biological Availability; Half-Life; Humans; Injections, Intravenous; Kinetics; Male; Propanolamines
PubMed: 7059422
DOI: 10.1111/j.1365-2125.1982.tb01364.x -
Military Medicine Dec 2020Anxiety disorders are among the most commonly diagnosed of psychiatric disorders. Many symptoms of posttraumatic stress disorder are also anxiety-related. Traditional...
INTRODUCTION
Anxiety disorders are among the most commonly diagnosed of psychiatric disorders. Many symptoms of posttraumatic stress disorder are also anxiety-related. Traditional medications used to treat these disorders, such as antidepressants and benzodiazepines, are often ineffective, not well-tolerated, and can be habit forming. An alternative agent is, therefore, needed. Beta-blockers are one class of medication with potential to treat anxiety-related disorders; however, current evidence remains limited and requires further characterization. To this end, this retrospective study aims to present a novel preliminary report on the use of the beta-blocker, atenolol, to potentially treat anxiety-related disorders.
MATERIALS AND METHODS
Ninety-two patients were identified from outpatient military mental health clinics in Okinawa, Japan, who had received atenolol for mental health-related symptoms. Primary measures collected were the rates of patient-reported (1) general beneficial/positive effect of atenolol, (2) adverse effects from atenolol, and (3) preference of atenolol to propranolol. Data were collected from patients who were given binary response options to report their perceived experiences for each primary measure. This study was approved by the Naval Medical Center San Diego Institutional Review Board.
RESULTS
The results showed 86% of patients reporting a positive effect and continuing to take atenolol, including 87% with a diagnosis of posttraumatic stress disorder, 100% with diagnosis of other specified trauma- and stressor-related disorder, and 81% diagnosed with anxiety disorders. In total, 90% of patients denied adverse effects or found the adverse effects tolerable. Additionally, 100% of patients who had previously taken propranolol for anxiety reported that they preferred atenolol.
CONCLUSIONS
The present preliminary observational data suggests that atenolol may be well-tolerated and effective among persons with anxiety disorders. These data also suggest that atenolol may be more effective and better tolerated than propranolol, which is the most commonly prescribed beta-blocker for these conditions; however, more rigorously controlled empirical studies are needed to further substantiate this claim. Despite an overwhelmingly high rate of positive reports from patients' self-evaluations of atenolol treatment for anxiety-related disorders, this early investigation was not placebo-controlled nor double-blinded, and formal outcome measures were not assessed due to a lack of availability. More detailed examinations are needed to further determine whether atenolol is a viable alternative or augmenting agent to propranolol, benzodiazepines, and antidepressants for anxiety disorders and trauma-related disorders.
Topics: Anxiety; Anxiety Disorders; Atenolol; Humans; Japan; Retrospective Studies
PubMed: 32728694
DOI: 10.1093/milmed/usaa170 -
Journal of Human Lactation : Official... Aug 2018Atenolol lactation information is limited, and controversy exists over the safety of its use during breastfeeding. In this study, important parameters including... (Observational Study)
Observational Study
BACKGROUND
Atenolol lactation information is limited, and controversy exists over the safety of its use during breastfeeding. In this study, important parameters including milk-to-plasma ratio, ratio of infant plasma to maternal plasma, infant daily dosage, and relative infant dose were investigated. The findings from this study add information to existing data about atenolol transfer in human milk. This may help guide health professionals in decision making regarding the safety of beta blockers used by mothers during breastfeeding. Research aim: The aims of the study were to quantify concentrations of atenolol in human plasma and milk, to evaluate atenolol pharmacokinetics in lactating women, and to investigate subsequent infant exposure to atenolol via mother's milk.
METHODS
In this prospective, longitudinal observational study, participants were lactating mothers ( N = 3), 1 to 4 months postpartum, who had been taking atenolol for therapeutic reasons, and one 4-month-old breastfed infant. Eight milk samples were collected over 24 hr at different time points, together with a single blood sample from each lactating mother and the infant, and quantified using a new sensitive liquid chromatography mass spectrometry method developed for this study.
RESULTS
Peak milk concentrations of atenolol were observed in the women at 4 hr (T) after oral administration. The dose-normalized maximum concentrations (C) of all patients were similar. The mean milk-to-plasma ratio of the patients who were taking 25 to 100 mg of atenolol was 8.57%. In the mother-infant pair study, the ratio (%) of infant plasma drug concentration to maternal plasma drug concentration observed (18.87%) was similar to the relative infant dose estimated (18.20%). The relative infant dose values (13.96%-18.20%) for all patients were within 10% to 25% of maternal dosage.
CONCLUSION
Atenolol use during breastfeeding should be undertaken with some precaution. If clinically indicated, an alternate beta blocker may be preferred.
Topics: Adult; Atenolol; Breast Feeding; Dose-Response Relationship, Drug; Female; Humans; Infant; Infant, Newborn; Infectious Disease Transmission, Vertical; Lactation; Longitudinal Studies; Milk, Human; Postpartum Period; Prospective Studies
PubMed: 29870669
DOI: 10.1177/0890334418771308