Atenolol vs. Benazepril

See how Atenolol and Benazepril compare on approved uses, dosing, side effects, and cost.

Key Takeaways

  • Atenolol is a beta-blocker approved for hypertension, angina, and stable heart attack recovery, while benazepril is an ACE inhibitor approved only for hypertension.

  • Both are taken once daily by mouth, but atenolol follows a simple three-step titration while benazepril offers more dose strengths for fine-tuning blood pressure control.

  • Atenolol must not be stopped abruptly and needs caution in lung disease, while benazepril carries a boxed warning for fetal harm and a rare risk of angioedema.

Atenolol vs. Benazepril Drug Summary

Atenolol

Atenolol is a beta-1 selective beta-blocker used to treat high blood pressure, angina, and to aid recovery after a stable heart attack. It comes as an oral tablet taken once daily.

Benazepril

Benazepril is an ACE inhibitor used specifically to lower blood pressure in hypertension. It comes as an oral tablet taken once daily.

Atenolol vs. Benazepril Side Effects

Atenolol

Most common
fatigue (up to 26%)
dizziness (up to 13%)
depression (up to 12%)
cold extremities (up to 12%)

Benazepril

Most common
headache (up to 6%)
dizziness (up to 4%)
somnolence (up to 2%)
postural dizziness (up to 2%)

Atenolol vs. Benazepril Dosage

Atenolol

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 50 mg once daily At the start
Maximum dose 200 mg once daily If needed
Dose changes 2 increases As tolerated

Benazepril

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 5 mg once daily At the start
Maximum dose 0.6 mg/kg once daily If needed
Dose changes 5 increases As tolerated

Atenolol vs. Benazepril Indications

Atenolol

Atenolol is FDA-approved for hypertension, angina pectoris, and to improve outcomes after a hemodynamically stable heart attack. Doctors also prescribe it off-label to prevent migraines and to reduce tremor.

  • Hypertension

  • Angina pectoris

  • Acute myocardial infarction (stable)

Benazepril

Benazepril is FDA-approved solely to lower blood pressure in hypertension. Dosing data for children as young as 6 suggest it can be used in that age group, though it is not approved under age 6.

  • Hypertension in adults

  • Hypertension in children 6 and older

  • May be used alone or added to other blood pressure medications

Atenolol vs. Benazepril Pros and Cons

Atenolol

Atenolol has decades of clinical use and covers angina and post-heart-attack care in addition to hypertension, giving it broader FDA-approved uses than benazepril. It requires careful tapering and closer monitoring in people with lung disease, slow heart rate, or kidney impairment.

Pros

  • Also treats angina and helps with recovery after a heart attack

  • Long-standing safety record, approved since 1981

  • Used off-label for migraine prevention and essential tremor

  • Simple once-daily dosing with a straightforward titration

Cons

  • Cannot be stopped abruptly without doctor guidance - risk of rebound angina or heart attack

  • Not suitable for people with asthma, COPD, bradycardia, or certain heart block

  • May mask warning signs of low blood sugar or an overactive thyroid

  • Needs dose adjustment in people with kidney impairment

Benazepril

Benazepril is approved specifically for hypertension and tends to cause fewer of the fatigue-type side effects associated with beta-blockers like atenolol. It carries a boxed warning against use during pregnancy and a rare but serious risk of angioedema.

Pros

  • Approved for use in children as young as 6 with hypertension

  • Lower risk of fatigue, cold extremities, and mood-related side effects seen with beta-blockers

  • Wide range of tablet strengths for fine-tuning the dose

  • Does not require heart-rate monitoring like a beta-blocker

Cons

  • Carries a boxed warning for fetal harm - must be stopped immediately if pregnancy occurs

  • Risk of angioedema, a rare but potentially life-threatening swelling reaction

  • Less effective as monotherapy in Black patients

  • Higher rate of treatment discontinuation due to side effects than placebo

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