Atenolol (Tenormin) and Black patients

Beta blockers, including atenolol, are not recommended as first-line therapy for uncomplicated hypertension in any adult — Black or non-Black — per the 2017 ACC/AHA guideline. For Black patients specifically, two points compound this general recommendation:

• Reduced BP-lowering effect. Beta blockers lower BP less effectively in Black patients than in white patients, similar to ACE inhibitors and ARBs (Flack et al., Hypertension 2010;56:780–800).
• Stroke signal. A 2005 meta-analysis (Lindholm et al., Lancet 2005;366:1545–53, PMID 16257341) showed atenolol specifically was associated with higher stroke risk compared to other antihypertensive classes, concerning in a population with a roughly 1.6-fold higher baseline stroke risk.

Atenolol remains appropriate when a Black patient has a compelling indication for a beta blocker: recent myocardial infarction, stable angina, heart failure with reduced ejection fraction (though carvedilol or metoprolol succinate are preferred for HF), or rate control for atrial fibrillation. Even in those settings, other beta blockers are often preferred — carvedilol for HF, metoprolol succinate for HF or post-MI — because atenolol is renally cleared and has less favorable outcomes data.