Lisinopril vs Atenolol

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For patients with high blood pressure or heart disease, certain drugs that modify the processes of the cardiovascular system can help in reducing blood pressure and managing symptoms. Lisinopril and Atenolol are two such drugs that are typically prescribed for these conditions. Each impacts different aspects of cardiovascular function but both have effects in lowering blood pressure and relieving strain on the heart. Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor which works by relaxing blood vessels so that blood can flow more easily, thus lowering overall blood pressure. Atenolol, on the other hand, belongs to a class of medications called beta blockers which work primarily by blocking the action of certain natural substances like adrenaline (epinephrine), affecting heart rate and blood flow through arteries and veins.

What is Lisinopril?

Lisinopril (sold under the brand name Prinivil and Zestril) is an ACE inhibitor that was approved by the FDA in 1987, marking a significant development from the earlier class of blood pressure medications known as beta-blockers. Lisinopril works by blocking a substance in your body that causes blood vessels to tighten, effectively keeping them open for longer periods. It's prescribed primarily to treat hypertension and heart failure. On the other hand, Atenolol (brand name Tenormin), which belongs to the class of drugs known as beta blockers, decreases heart rate and dilates blood vessels but has a stronger effect on slowing down your heartbeat than expanding your arteries. This means it can have more side effects related to low heart rate such as fatigue or dizziness compared to lisinopril. Both these medications are used extensively for managing cardiovascular conditions though their mechanisms of action differ.

What conditions is Lisinopril approved to treat?

Lisinopril is approved for the treatment of various cardiovascular conditions:

  • Hypertension, also known as high blood pressure
  • Heart failure in patients who do not tolerate angiotensin-converting enzyme (ACE) inhibitors
  • Reduction of mortality or hospitalization in patients with left ventricular systolic dysfunction (LVSD)

On the other hand, Atenolol is primarily used to manage:

  • Angina, a type of chest pain caused by reduced blood flow to the heart
  • Hypertension
  • To help prevent future heart attacks in those who have had one

How does Lisinopril help with these illnesses?

Lisinopril is instrumental in managing hypertension by reducing the production of a chemical called angiotensin II. Angiotensin II causes blood vessels to narrow and releases another substance that promotes salt and water retention, both contributing to high blood pressure. Lisinopril works by inhibiting an enzyme involved in producing this potent vasoconstrictor, thus keeping levels lower for longer periods of time. Blood vessels then relax and dilate which results in lowered blood pressure. This facilitates smoother, more efficient circulation throughout the body helping patients manage their condition and maintain a stable cardiovascular state.

On the other hand, Atenolol operates on a different mechanism. It belongs to a group of drugs known as beta-blockers that function mainly by slowing down heart rate and reducing its workload thereby lowering blood pressure. Beta-blockers accomplish this by blocking the action of certain chemicals such as adrenaline (a stress hormone) on your heart.

What is Atenolol?

Atenolol, available under the brand name Tenormin among others, is a beta blocker. This means it works by blocking the action of certain natural substances such as adrenaline (epinephrine) on the heart and blood vessels. By doing this, atenolol reduces heart rate, blood pressure and strain on the heart following a myocardial infarction (heart attack). Atenolol was first approved by FDA in 1981.

As atenolol does not have significant effects on renin-angiotensin-aldosterone system like lisinopril does, its side-effect profile is different to that of ACE inhibitors such as lisinopril. For instance, it doesn't typically cause a persistent cough or swelling of tissue beneath the skin (angioedema), which are common side effects associated with ACE inhibitors like Lisinopril. However, patients who switch from an ACE inhibitor to atenolol should be aware that possible side effects can include cold hands and feet or worsening of existing psoriasis symptoms.

The actions on norepinephrine make Atenlol beneficial for treating hypertension especially in patients who do not respond well to "typical" drugs inhibiting renin–angiotensin–aldosterone system such as Lisnopril.

What conditions is Atenolol approved to treat?

Atenolol is a medication that has garnered approval for the management of conditions like:

  • Hypertension, also known as high blood pressure
  • Angina pectoris, chest pain usually caused by reduced blood flow to the heart
  • Management after a heart attack to improve survival

How does Atenolol help with these illnesses?

Atenolol is a type of medication known as a beta-blocker. It works by diminishing the effects of certain chemicals in the body, particularly epinephrine (also referred to as adrenaline), which plays significant roles in various bodily functions such as heart rate regulation, blood pressure maintenance, and stress response. Atenolol's action on these processes results in decreased heart rate and blood pressure, making it an effective treatment for hypertension or high blood pressure and angina or chest pain.

Unlike Lisinopril, which primarily inhibits angiotensin converting enzyme leading to dilation of blood vessels, Atenolol primarily affects the heart itself by slowing down its activity. This makes Atenolol more suitable for patients with conditions like arrhythmia where controlling heart rhythm is crucial while Lisinopril might be preferred when vasodilation could provide more benefits like in cases of congestive heart failure. Thusly, based on patient-specific needs and responses to medications, Atenolol may be prescribed over Lisinopril or vice versa.

How effective are both Lisinopril and Atenolol?

Both Lisinopril and Atenolol have validated histories of success in treating patients with hypertension, and they were both approved by the FDA during a similar time frame. Since they act through different mechanisms, they may be prescribed under separate circumstances. The effectiveness of Lisinopril (an ACE inhibitor) and Atenolol (a beta-blocker) in managing hypertension was directly studied in numerous clinical trials, showing that the two drugs have comparable efficacy in lowering blood pressure as well as exhibiting dependable safety profiles.

A 2004 meta-analysis demonstrated that Lisinopril is effective at reducing systolic and diastolic blood pressure from early stages of treatment; its side effect profile is often considered favorable over many other antihypertensive medications because it lacks metabolic side effects. Additionally, it's been reported to reduce cardiovascular events including heart attacks, strokes, or death related to cardiovascular disease. It has thus become one of the most commonly prescribed antihypertensive drugs worldwide.

On the other hand, a 2016 systematic review indicated that Atenolol seems to be more effective than placebo at reducing high blood pressure but appears less effective compared to other first-line treatments for chronic hypertension according to some studies. This makes Atenolol typically considered a second- or third-line treatment option—usually prescribed after calcium channel blockers or thiazide diuretics—or for specific conditions like angina pectoris or certain cardiac arrhythmias where beta-blockers are particularly beneficial due their unique mechanism action on heart rate control.

abstract image of a researcher studying a bottle of drug.

At what dose is Lisinopril typically prescribed?

Oral dosages of Lisinopril range from 10–40 mg per day, but studies have indicated that a daily dosage of 20 mg is sufficient for most people in the treatment of hypertension. For patients with heart failure or post-myocardial infarction, the dose may be started at 5 mg/day and then increased as needed. In comparison, Atenolol is typically prescribed at an initial oral dose of 50 mg once daily, which can be increased to a maximum dosage of 100 mg per day if necessary. With both medications it's important to monitor blood pressure regularly and adjust doses accordingly under medical supervision.

At what dose is Atenolol typically prescribed?

Atenolol therapy is typically initiated at a dosage of 25-50 mg taken orally once daily. If necessary, the dose can be increased to 100 mg per day as a single dose or divided into two doses, spaced approximately 12 hours apart. The maximum recommended dose is 200 mg/day and may be considered if there's no adequate response to treatment at lower dosages. It should be noted that changes in heart rate or blood pressure are not immediate upon starting Atenolol, it often takes one to two weeks for full effects to become noticeable.

What are the most common side effects for Lisinopril?

Some of the most common side effects of Lisinopril as compared to Atenolol include:

  • Dizziness or lightheadedness, especially when getting up from a lying or sitting position
  • Dry cough
  • Fatigue and weakness (asthenia)
  • Headache
  • Nausea and diarrhea
  • Rash and itching
  • Increased potassium levels, which can cause muscle weakness, irregular heartbeat
  • Decreased kidney function

Atenolol on the other hand has its own set of potential side effects such as:

  • Fatigue and drowsiness (somnolence)
  • Cold hands or feet
  • Insomnia
  • Shortness of breath
  • Slow heart rate
  • Low blood pressure, which may cause dizziness or fainting
  • Erectile dysfunction

It's important to note that not everyone will experience these side effects. If you do have any concerns regarding your medication's side effects, it is best to consult with your doctor.

abstract image of a patient experiencing side effect

Are there any potential serious side effects for Lisinopril?

While both Lisinopril and Atenolol are used to manage high blood pressure, their side effects differ. When taking Lisinopril, be aware of the following potential serious side effects:

  • Severe allergic reactions characterized by symptoms such as hives; severe stomach/abdominal pain; difficulty breathing; swelling of your face, lips, tongue or throat.
  • Signs of kidney problems like change in the amount of urine produced, bloody or cloudy urine.
  • Symptoms like fainting spells, irregular heartbeat that might indicate liver issues
  • Yellowing eyes/skin which can denote jaundice
  • High potassium levels which may cause muscle weakness, slow irregular heartbeat.

Atenolol also has its unique set of potential severe side effects including but not limited to:

  • Slow heart rate (bradycardia)
  • Sensations of wheezing or shortness breath
  • Sudden weight gain
  • Swelling hands/ankles/feet A sudden worsening condition could indicate a serious reaction. If any significant changes occur while on either medication it is critical you seek medical attention immediately.

What are the most common side effects for Atenolol?

Atenolol, a beta-blocker often used to manage conditions such as hypertension and angina, has been associated with the following potential side effects:

  • Drowsiness or tiredness
  • Cold hands and feet
  • Insomnia or other sleep disturbances
  • Shortness of breath
  • Nausea, vomiting, and abdominal discomfort
  • Slow heartbeat
  • Light-headedness or dizziness.

In rare cases, Atenolol may also cause mood changes or feelings of depression. It's important to note that while these side effects can occur they do not affect every individual who takes Atenolol. If you experience any severe symptoms it's crucial to seek immediate medical attention.

Are there any potential serious side effects for Atenolol?

Atenolol is generally well-tolerated, but like any medication, it can have potential side effects. Some of the more serious ones include:

  • Signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat
  • A slow heart rate with dizziness and fatigue
  • Shortness of breath (even with mild exertion)
  • Swelling in your ankles or feet
  • Cold feeling in your hands and feet
  • Severe skin reactions such as Stevens-Johnson syndrome that may cause symptoms like blistering red rash, peeling skin etc.
  • Mood changes including feelings of depression

If you experience any of these side effects while taking atenolol, seek immediate medical attention. It's also worth noting that stopping atenolol abruptly can lead to worsening chest pain or a heart attack - so always talk to your doctor before making changes to how you take this medication.

Contraindications for Lisinopril and Atenolol?

Both Lisinopril and Atenolol, like most other medications for hypertension or heart conditions, may cause certain side effects in some individuals. If you experience severe dizziness, fainting, weakness or unusual fatigue while taking these drugs, please seek immediate medical attention.

Neither Lisinopril nor Atenolol should be taken if you are using certain medicines that interact with them. These include potassium supplements or salt substitutes containing potassium as well as any medication that increases the amount of potassium in your body. Always inform your doctor about all the medications you're currently taking; this includes prescription drugs, over-the-counter products and herbal supplements.

It's crucial to remember that abrupt withdrawal from either of these medications can lead to a rapid increase in blood pressure or chest pain. Therefore, it is important not to stop taking Lisinopril or Atenolol without prior consultation with your physician.

How much do Lisinopril and Atenolol cost?

For the brand name versions of these drugs:

  • The price for 30 tablets of Zestril (lisinopril 20 mg) averages around $70, which works out to approximately $2.33/day.
  • The price for 60 tablets Tenormin (atenolol 50 mg) averages around $190, working out to roughly $3.17/day.

Thus, if you are taking a standard dosage for either drug, lisinopril is less expensive on a per-day treatment basis than atenolol. It's important to remember that cost should not be your only consideration when deciding between these medications; their effectiveness and side-effect profiles must also be considered.

As for generic versions of Lisinopril and Atenolol:

  • Lisinopril (20 mg tablets) is available in packs from 30 up to 90 with approximate costs as low as $0.14 per day depending on the pack size.
  • Generic Atenolol can cost anywhere from about $0.15 - $1 per day depending on your dosage and where it's purchased.

Overall, the prices vary but both options present affordable choices compared to many other prescription medications.

Popularity of Lisinopril and Atenolol

Lisinopril, in its generic form as well as under brand names such as Prinivil and Zestril, was estimated to have been prescribed to more than 87 million people in the US in 2020. It is an ACE inhibitor used primarily for treating hypertension and heart failure. Lisinopril accounted for nearly 23% of all antihypertensive prescriptions in the US during that period.

Atenolol, both generic and under brand names like Tenormin, was prescribed to around 12 million people in the USA over the same time period. Atenolol accounts for approximately 3% of beta-blocker prescriptions which are frequently used for conditions such as angina pectoris (chest pain), hypertension or irregular heartbeat. The prevalence of atenolol has been slightly decreasing over recent years due to concerns about its lower efficacy compared with other beta blockers.


Both Lisinopril and Atenolol have long-standing records of usage in patients with hypertension, supported by numerous clinical studies indicating their effectiveness compared to placebo treatments. Both drugs may be used together under a physician's guidance but generally they are prescribed separately due to their different mechanisms of action. Lisinopril is an ACE inhibitor that works primarily by blocking the conversion of angiotensin I into angiotensin II, thus relaxing blood vessels; whereas Atenolol is a beta-blocker that mainly reduces heart rate.

Lisinopril is often considered a first-line treatment option for hypertension, especially in patients who also have diabetes or kidney disease. Atenolol would usually be considered if lisinopril isn't tolerated well or contraindicated due to certain conditions such as pregnancy.

Both drugs are available in generic form which represents significant cost savings for patients paying out-of-pocket expenses. It should be noted that both Lisinopril and Atenolol may require an adjustment period, meaning effects might not be noticeable right away.

The side effect profile between these two medications differs significantly: while both being generally well-tolerated, common side effects of Lisinopril include coughing and light-headedness upon standing up; whereas fatigue and cold hands or feet are more associated with atenolol use. For both medications, any sudden changes in heartbeat patterns or feelings of faintness warrant immediate medical attention.