Losartan vs. Atenolol

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

Key Takeaways

  • Losartan is an ARB that lowers blood pressure and also protects the kidneys in type 2 diabetes, while atenolol is a beta-blocker that also treats angina and helps after a heart attack.

  • Losartan tends to be better tolerated overall, with lower rates of fatigue and mood changes than atenolol.

  • Atenolol must never be stopped abruptly, since sudden discontinuation can trigger chest pain or a heart attack, a risk losartan does not carry.

Losartan vs. Atenolol Drug Summary

Losartan

Losartan is an angiotensin receptor blocker (ARB) that lowers blood pressure by blocking the effects of a hormone that narrows blood vessels. It is taken as a tablet once a day and is also used to protect the kidneys in type 2 diabetes and to lower stroke risk in certain heart conditions.

Atenolol

Atenolol is a beta-1 selective beta-blocker that lowers blood pressure by slowing the heart rate and reducing how hard the heart works. It is taken as a tablet once a day and is also approved for angina and for use after a stable heart attack.

Losartan vs. Atenolol Side Effects

Losartan

Most common
upper respiratory infection (up to 8%)
dizziness (up to 3%)
nasal congestion (up to 2%)
back pain (up to 2%)

Atenolol

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

Losartan vs. Atenolol Dosage

Losartan

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 25 mg once daily At the start
Maximum dose 100 mg once daily If needed
Dose changes 2 increases As tolerated

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

Losartan vs. Atenolol Indications

Losartan

Losartan is an angiotensin receptor blocker (ARB) that lowers blood pressure in adults and children over 6. It also slows kidney damage in type 2 diabetes and lowers stroke risk in people with high blood pressure and an enlarged heart muscle.

  • Hypertension in adults and children over 6 years old

  • Diabetic nephropathy with type 2 diabetes and protein in the urine

  • Stroke risk reduction in hypertension with an enlarged heart muscle

  • Sometimes used off-label for heart failure

Atenolol

Atenolol is a beta-blocker that lowers blood pressure and treats angina, the chest pain caused by reduced blood flow to the heart. It is also used after a stable heart attack to help protect the heart from further damage.

  • Hypertension

  • Angina pectoris (chest pain from reduced heart blood flow)

  • Acute myocardial infarction, once hemodynamically stable

  • Off-label for migraine prevention

Losartan vs. Atenolol Pros and Cons

Losartan

Losartan has a favorable side effect profile with low rates of fatigue and mood-related complaints, and it adds kidney-protective benefits for people with diabetes. It is available as a low-cost generic and is covered by most insurance plans.

Pros

  • Well tolerated, with low rates of fatigue and depression

  • Also protects the kidneys in type 2 diabetes with protein in the urine

  • Reduces stroke risk in hypertension with an enlarged heart muscle

  • Does not worsen asthma or COPD the way beta-blockers can

Cons

  • Can raise blood potassium levels, requiring monitoring

  • Not safe during pregnancy

  • Takes several weeks to reach full blood-pressure-lowering effect

  • Kidney function should be checked after starting or increasing the dose

Atenolol

Atenolol also treats angina and helps protect the heart after a heart attack, giving it uses beyond blood pressure control. It is inexpensive and widely available, but it carries added precautions around abrupt discontinuation and certain heart rhythm conditions.

Pros

  • Also approved for angina and for use after a heart attack

  • Long-established option with decades of clinical use

  • Can be combined with other heart medications after a heart attack

  • Also used off-label for migraine prevention and hand tremor

Cons

  • Cannot be stopped suddenly without risking chest pain or heart attack

  • Contraindicated in certain slow heart rhythms and heart block

  • More likely to cause fatigue and mood changes such as depression

  • Caution needed in asthma or COPD due to airway-tightening risk

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