From the Guidelines
Beta blockers that are preferred for nighttime administration include nebivolol, bisoprolol, and metoprolol succinate due to their longer half-lives and once-daily dosing capabilities. These medications can be particularly beneficial when taken at night because they help reduce early morning blood pressure surges, which often occur between 6 AM and noon when cardiovascular events are more common 1. Nebivolol (5-10 mg) and bisoprolol (5-10 mg) are especially advantageous for nighttime use as they are cardioselective, meaning they primarily target the heart with fewer systemic side effects. Metoprolol succinate (25-200 mg) in its extended-release form provides steady 24-hour coverage when taken at night.
Some key points to consider when selecting a beta blocker for nighttime administration include:
- The medication's half-life and dosing frequency, with once-daily dosing being preferred for nighttime administration
- The presence of cardioselectivity, which can reduce systemic side effects
- The potential for minimizing daytime fatigue, a common side effect of beta blockers
- Individual patient factors, such as comorbidities and other medications, which may influence the optimal timing for beta blocker administration
Taking these beta blockers in the evening may also minimize daytime fatigue, a common side effect. However, patients should consult their healthcare provider before changing their medication schedule, as individual factors like comorbidities and other medications may influence the optimal timing for beta blocker administration.
From the Research
Beta Blockers and Sleep
- The study 2 compared the impact of metoprolol succinate and nebivolol on sleep quality in patients with stage 1 hypertension, and found that nebivolol was associated with improved sleep, whereas metoprolol was associated with a worsening of sleep characteristics.
- Another study 3 found that long-term treatment with metoprolol or carvedilol was associated with a lower prevalence and severity of central sleep apnoea, and improved sleep quality and daytime sleepiness.
Preferred Beta Blockers for Nighttime Use
- Based on the studies, carvedilol and nebivolol may be preferred beta blockers for nighttime use due to their association with improved sleep quality and reduced sleep disturbances 2, 3.
- Metoprolol, on the other hand, was found to worsen sleep characteristics in one study 2, but was associated with improved sleep quality and reduced central sleep apnoea in another study 3.
- Bisoprolol was not specifically studied in the context of sleep, but was found to have similar effects on mortality as carvedilol and metoprolol succinate in patients with chronic heart failure 4.
Comparison of Beta Blockers
- A meta-analysis 5 found that carvedilol significantly reduced all-cause mortality compared to β(1)-selective beta blockers (atenolol, bisoprolol, metoprolol, and nebivolol) in patients with systolic heart failure.
- Another study 6 reviewed the pharmacology and pharmacokinetics of commonly used beta blockers, and found that different beta blockers have distinct properties that may influence their effects on sleep and other outcomes.