Atenolol (Page 4 of 6)

Acute Myocardial Infarction

In a series of investigations in the treatment of acute myocardial infarction, bradycardia and hypotension occurred more commonly, as expected for any beta-blocker, in atenolol-treated patients than in control patients. However, these usually responded to atropine and/or to withholding further dosage of atenolol. The incidence of heart failure was not increased by atenolol. Inotropic agents were infrequently used. The reported frequency of these and other events occurring during these investigations is given in the following table.

In a study of 477 patients, the following adverse events were reported during either intravenous and/or oral atenolol administration:

Conventional TherapyPlus Atenolol(n=244)Conventional TherapyAlone(n=233)
Bradycardia43(18%)24(10%)
Hypotension60(25%)34(15%)
Bronchospasm3(1.2%)2(0.9%)
Heart Failure46(19%)56(24%)
Heart Block11(4.5%)10(4.3%)
BBB + Major Axis Deviation16(6.6%)28(12%)
Supraventricular Tachycardia28(11.5%)45(19%)
Atrial Fibrillation12(5%)29(11%)
Atrial Flutter4(1.6%)7(3%)
Ventricular Tachycardia39(16%)52(22%)
Cardiac Reinfarction0(0%)6(2.6%)
Total Cardiac Arrests4(1.6%)16(6.9%)
Nonfatal Cardiac Arrests4(1.6%)12(5.1%)
Deaths7(2.9%)16(6.9%)
Cardiogenic Shock1(0.4%)4(1.7%)
Development of Ventricular Septal Defect0(0%)2(0.9%)
Development of Mitral Regurgitation0(0%)2(0.9%)
Renal Failure1(0.4%)0(0%)
Pulmonary Emboli3(1.2%)0(0%)

In the subsequent International Study of Infarct Survival (ISIS-1) including over 16,000 patients of whom 8,037 were randomized to receive atenolol treatment, the dosage of intravenous and subsequent oral atenolol was either discontinued or reduced for the following reasons:

*Full dosage was 10 mg and some patients received less than 10 mg but more than 5 mg.
Reasons for Reduced Dosage
IV Atenolol Reduced Dose(< 5 mg)*Oral Partial Dose
Hypotension/Bradycardia105(1.3%)1168(14.5%)
Cardiogenic Shock4(.04%)35(.44%)
Reinfarction0(0%)5(.06%)
Cardiac Arrest5(.06%)28(.34%)
Heart Block (> first degree)5(.06%)143(1.7%)
Cardiac Failure1(.01%)233(2.9%)
Arrhythmias3(.04%)22(.27%)
Bronchospasm1(.01%)50(.62%)

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