View Full Version : Atenolol and BP

08-01-2004, 04:59 AM
I saw my cardiologist the other day and we discussed raising my Atenolol to 75mg. When I expressed concern over my BP dropping too low, he said that Atenolol doesn't effect normal BP. It only lowers high BP. This sounds fishy. Is this accurate info or is he trying to pull the wool over my eyes.

Thanks all

08-01-2004, 10:52 AM
I think you are right to be concerned. Medication doesn't know what your BP is --it only does what it is designed to do.

I have been on one beta--blocker or another since I was 13 and my bp unmedicated is totally normal. On a beta-blocker, it is lower. Duh!

What is your bp and heart rate now? What is your dose now? It isn't a linear progression (eg if you double your dose your bp won't drop double the amount) but I would be getting my rear to a specialist or conferring with the one you already have it you have one.

take care,


08-01-2004, 08:22 PM
Thanks, I didnt' think it sounded right. Why he would tell me that I don't know...maybe he thinks I'm stupid. :D
My BP resting is 110/65ish, my HR is about 75-80bpm. I had LESS problems(arrythmias etc) when my heartrate was over 100(yrs ago). So I don't know if things are worsening, changing with age.

I am trying as we speak to get to see a specialist, my problem(and there always is one) is that I would have to drive 30+ hours to see one. I could fly-but I would have to be heavily sedated...:D:D. I have been working on going to Minneapolis(5 hour drive) but it doesn't sound promising.
Thanks for your help

08-10-2004, 03:34 PM

I am on a BP Rx and my doc has also put me on atenolol 50 mg once a day. Yes it does lower blood presure.


08-10-2004, 04:15 PM

I would se another doctor your med doesn't know how low or high you BP is it will lower your BP even more


08-10-2004, 04:30 PM
This just proves we have to "take the bull by the horns" and pay attention to our treatment. Doctors are not gods, they are human like us all. Some don't have all the information they should have regarding some Rx's as well as treatment for HOCM etc.

Stay alert and pay attention to the treatment you are getting.


08-10-2004, 05:05 PM

Atenolol is most often prescribed to lower blood pressure, so of course you have every right to be concerned. We HCM'ers just take it for it's other benefits and hope that it doesn't drop our BP too much.

I think i know what your doctor was trying to tell you, even if he did word it rather poorly. For some of us, it seems that atenolol does a good job of lowering our heartrate without effecting our blood pressure too much. My own doctor gave me a rather long and complicated explanation of how all this works, but i believe the short version is that the beta blocker's effect on an HCM heart is a little bit different than that of a normal heart. It has the same potential to lower blood pressure, but with us HCM'ers, the primary effect of lowering the heartrate can kick in before the blood pressure is effected too much.

I can tell you from my own experience that i have taken as much as 250mg of atenolol daily, and it did not lower my blood pressure by very much... maybe ten points plus or minus. I can also tell you that it was only at the intial dose that i saw any drop at all. Anything above 100mg has had no adverse effect. Unfortunately the only way any of us have of knowing these things is by trial and error... so we experiment and see what works well for each of us.

As for the arrhythmias, these can be caused (or at least worstened) in part by the atenolol. I had a substantial increase in the number of PVC's i experienced after going on it. However, the benefits from my taking it have far outweighed the negative.

Take care,


08-11-2004, 07:39 PM
Pam, Jim is so right about the individual response to the med. Don't just assume your doctor gave you wrong information. If you expect to continue to see him, ask him for more complete info, a better explanation, and tell him your concerns. Ask him for specific guidelines and parameters for your expected BP and heart rate on that dose. Then call him if they go lower or you have other problems such as dizziness. Atenolol may not lower your BP to a problem level, or you may notice that it does so at certain times. You may have to stand up more slowly,etc, to give your body time to adjust to the dose. It can help to eliminate irregular heart beats in some people, even tho others, like Jim, have not had this experience. It's fine to get other peoples stories and experiences from the message board, it helps you to learn and know when to question. But remember, this is not medical information or advice, you must get that from your doctor. Linda

10-11-2004, 02:07 AM
I have been on Atenolol for HCM for 5 years. And for the last 4 years I have been on Florinef Acetate just for the purpose of raising the BP that the Atenolol lowers. It works for me. Talk to your doc.

10-27-2004, 03:11 AM
Thanks for your helpful replies. I have sinced asked my Dr(GP) about what the cardio said and he agreed, that in general, atenolol does not lower normal BP. I assume now that THEY know what they are talking about and have chosen to leave it alone.
Thanks all for your wise insight....

10-27-2004, 09:45 AM

Have you started on the increased dose of Atenolol yet? What has been the effect on your blood pressure, etc.? Hope you are doing well :)


10-27-2004, 01:31 PM
Jim, I did up the dose from 50mg to 75mg without any change to my BP. I do feel better, except for the arrhythmias, they seem to be worse. Thanks for your concern, hope you are well, I haven't had a chance to read the 455 new messages since the last time I was here, I will get around to it though. :)

Take care

Burton Borrok
10-27-2004, 11:36 PM
Abbygirl Pam,
We missed you. I hope this posting means that you are going to be with us again. That would be very nice indeed.

About the Atenolol, I would suggest taking an occasional blood pressure reading and monitor whether or not you show any change over time. As I’m sure you know, no medication will turn itself on or off based on the person’s need. If that were the case we would all be taking a giant pill containing all the medications, and our body would then select the drugs it needs from the assortment.

Actually there are some exceptions to that rule, in that the body will dispose of an overdose of some things, keeping only what it needs. As an example, for most people who use an excessive amount of salt, the excess is just voided and never used. Of course if the body has its own maladies, that process may not function as it should. However when it comes to most drugs, such as Atenolol, it is fully absorbed into the system. Maybe its effectiveness is altered one way or the other based on the balances in the system already, but an increase or decrease of the dosage will have its effect. At least that is the way it was explained to me, and my own experiences have confirmed it.

If one person told you to jump off a tall building you would think they were crazy. If ten people told you to do it, you would think they were all crazy. You would not put your own logic aside and go jump would you? This is the same thing.

Nice to have you back,

10-28-2004, 12:39 AM

I'm glad to hear that the increased dose is going well for you so far.

For most of us, no one drug or combination of drugs is going to make us feel 100 percent better, so remember that there will probably be trade-offs. The only real guage for the effectiveness of any HCM med is one that can't be measured... it's all about symptom management, and how the drug makes us feel. You may find that you experience a few more PVC's on the atenolol, but that overall you feel much better. Or you may find that a different drug works just as well and with fewer side-effects. It'll take some time, so try not to get discouraged.

It sounds like your doc is taking you up in small increments and seeing how this affects you, which is good standard protocol. Be sure to keep your doctor apprised of any changes you note on the increased dose. I found that it was helpful to keep a daily log and jot down my BP and heartrate every day, as well as a few words about how i felt in general on the new dose.

Hang in there, and thanks for writing back. :)


12-06-2004, 02:50 AM
whoa you guys are talkin about taking 50 mg a day, im on 200 mg of atelenol and 400 mg of norpace-a day. im only 16 but is that an insane amount?

Burton Borrok
12-06-2004, 11:24 AM
Well Ise,
We are all different and so each of us requires different amounts of medication to control our individual problems.

Online Atenolol Use Indication:
The dose of Atenolol beta-blocker will be different for different patients. Follow your doctor's instructions or the directions on the label. The following information includes only the average Atenolol doses. If your dose is different, do not change it unless your doctor tells you to do so.
The number of Atenolol capsules or tablets or teaspoonfuls of solution that you take depends on the strength of the medicine. Also, the number of Atenolol doses you take each day, the time allowed between doses, and the length of time you take Atenolol medicine depend on the medical problem for which you are taking the beta-blocker.

Medication Atenolol Side Effects:
Check with your doctor as soon as possible if any of the following Atenolol side effects occur:
Less common Atenolol side effects:
Breathing difficulty and/or wheezing; cold hands and feet; mental depression; shortness of breath; slow heartbeat (especially less than 50 beats per minute); swelling of ankles, feet, and/or lower legs
Rare Atenolol side effects:
Back pain or joint pain; chest pain ; confusion (especially in elderly patients); dark urine—for acebutolol, bisoprolol, or labetalol; dizziness or lightheadedness when getting up from a lying or sitting position; fever and sore throat; hallucinations (seeing, hearing, or feeling things that are not there); irregular heartbeat; red, scaling, or crusted skin; skin rash; unusual bleeding and bruising; yellow eyes or skin—for acebutolol, bisoprolol, or labetalol
Signs and symptoms of Atenolol overdose
Slow heartbeat; dizziness (severe) or fainting; fast or irregular heartbeat; difficulty in breathing; bluish-colored fingernails or palms of hands; convulsions (seizures)


Norpace and Norpace CR are indicated for the treatment of documented ventricular arrhythmias, such as sustained ventricular tachycardia, that, in the judgment of the physician, are life-threatening. Because of the proarrhythmic effects of Norpace and Norpace CR, their use with lesser arrhythmias is generally not recommended. Treatment of patients with asymptomatic ventricular premature contractions should be avoided.
Initiation of Norpace or Norpace CR treatment, as with other antiarrhythmic agents used to treat life-threatening arrhythmias, should be carried out in the hospital. Norpace CR should not be used initially if rapid establishment of disopyramide plasma levels is desired.
Antiarrhythmic drugs have not been shown to enhance survival in patients with ventricular arrhythmias.

The dosage of Norpace or Norpace CR must be individualized for each patient on the basis of response and tolerance. The usual adult dosage of Norpace or Norpace CR is 400 to 800 mg per day given in divided doses. The recommended dosage for most adults is 600 mg/day given in divided doses (either 150 mg every 6 hours for immediate-release Norpace or 300 mg every 12 hours for Norpace CR). For patients whose body weight is less than 110 pounds (50 kg), the recommended dosage is 400 mg/day given in divided doses (either 100 mg every 6 hours for immediate-release Norpace or 200 mg every 12 hours for Norpace CR).

For patients with cardiomyopathy or possible cardiac decompensation, a loading dose, as discussed below, should not be given, and initial dosage should be limited to 100 mg of immediate-release Norpace every 6 to 8 hours. Subsequent dosage adjustments should be made gradually, with close monitoring for the possible development of hypotension and/or congestive heart failure (see WARNINGS).

For patients with moderate renal insufficiency (creatinine clearance greater than 40 ml/min) or hepatic insufficiency, the recommended dosage is 400 mg/day given in divided doses (either 100 mg every 6 hours for immediate-release Norpace or 200 mg every 12 hours for Norpace CR).

For patients with severe renal insufficiency (Ccr 40 ml/min or less), the recommended dosage regimen of immediate-release Norpace is 100 mg at intervals shown in the table below, with or without an initial loading dose of 150 mg.

I hope this is of some help to you.

12-06-2004, 02:54 PM
200 mg. of atenolol is on the high end, but its not that unusual for HCM patients. I take 175 mg. myself, and my Dr. may raise to 200. I accidentally took 200 mg. yesterday and lived to tell the story.

You seem to be on the standard dose of Norpace. I don't know about taking the two together, but I am sure your docs at UCLA know what they are doing.

Pam Alexson
12-06-2004, 06:28 PM
I take 250 mgs of Atenolol and I have had a myectomy one year ago. We all need different amounts. I do not take any anti- arrythmia meds as well ( Norpace is one) or calcium channel blockers.

04-21-2005, 02:57 PM
Hi again
I am taking 200mg of Atenonal daily, I was on Mexelatine for prevention of Arrythmias, but the new HCM Dr.s told me I should stop the Mexelitine and double dose of Tenormin (Generic Atenanol does not work for me) MY BP has dropped down since the Dr. doubled the dose 3/2. I have no symtoms that Iv'e noticed, just had ICD recall battery changed on 4/12 found out while in hospital. BP went down 90/40 no symtoms, yesterday was 110/50 when I had the dressing changed. I was told to check it daily, when I went to purchase one of those BP Readers, they wanted 100 dollars for one. I Just always feel tired and very heavy chest if exertion comes on like my heart can't increase beat when it needs to. Thanks for all the helpful imformation You guys are great!!!

04-21-2005, 08:16 PM
HCMers as a whole, I think, need larger doses than non-HCM patients. Our hearts are really working overtime.

I took huge amounts of Norpace and I now take 100mg of Toprol XL (a 12 hour tablet) every 8 hours and could go higher.

I weigh 115 lbs.

04-22-2005, 08:39 AM
Hi, Loutinmanswife,

Indeed your heart probably can't increase its beat (at least not to the degree that it did before beta blockers). That is part of what beta blockers do.

As far as the price of bp devices goes, my take is that the wrist ones, if that is what you are looking at, are not accurate. My mother-in-law has one and we checked it for consistency, and found it was not. The old fashioned cuffs and stethoscope are better, I think. We got one complete with a mercury manometer for $12 here in China, but, although you cannot possibly get one of these for anything close to that in the US, you should be able to find one with a gauge for a lot less than $100. I bought the mercury one a couple of years ago because I thought my gauge was going out, but it turned out to be that my bp was really fluctuating so much that I thought the thing was broken. So, I use the gauge one most of the time still.


michael obrien
04-22-2005, 08:49 PM
just a dumb question .what is the difference between altenol and toprol if their is a difference.thanks mike

05-15-2005, 05:44 PM
I am a technecrat (gadget geek) and last year wanted a device to measure B.P. and save the readings and date/time for presentation to the M.D. on my visits.
I found just the item in the Omron HEM-780 (as shown on their website) thus:
It saves the readings for 90 recordings. It will do about 100 +- recordings on (4) AA batteries or the A/C adapter is included.
It has a large cuff which is curved to better fit the arm and attaches with Velcro. It uses (2) buttons to make a reading, one to turn on/off (also automatically will turn off after some time and the second to take the reading. It is consistent in it's recordings. It shows the date, time, pulse, systolic, diastolic when you select the memory feature. I just transfer the readings manually into a spreadsheet and print it out for my M.D.. This allows me to do an averaging for him.
I bought it via one of the on-line purchasing tools (Priceline or whatever) for about $80+-. I believe it came from CA within 5 days.
When I was at the Mayo they used a walkaround monitor to take my B.P. every 10 minutes and it was about 5"x4"x3/4" and hung around your neck and attached to the cuff which stayed wrapped around my arm. I'd have preferred a similar one as the Omron is to bulky to carry around in my daily activities.
The Omron brand came well recommended per a few testing labs. Maybe CR? I forget.
It looks like they've slightly changed the style from the one I got last July.
It takes about 10-15 seconds to do a reading. It compares to my Tyco manual setup from my EMT days.
Let me know if you need any assistance in this area.

05-15-2005, 06:29 PM
atenolol is the generic for Tenormin and Toprol is the brand name for metoprolol (confused yet?). metoprolol is also called Lopressor.

both are beta-blockers, they just have slightly different chemical compositions. you can google them to get technical details.