From the Guidelines
Beta blockers should be considered as a first-line treatment for patients with hypertension, especially those with concomitant diseases and conditions that benefit from beta-blocker treatment, as they have been shown to provide morbidity and mortality benefits, as well as improve quality of life, as demonstrated in the most recent study from 2022 1.
Key Points
- Beta blockers are indicated for numerous diseases and conditions beyond hypertension, including cardiovascular diseases, endocrine diseases, anxiety, and psychiatric disorders.
- The choice of beta blocker should be individualized based on the patient's specific condition and comorbidities, with cardioselective beta blockers like metoprolol and bisoprolol often preferred for patients with respiratory conditions.
- Beta blockers have been shown to provide cardiovascular prevention when used in combination with other cardiovascular drugs, such as diuretics, and should be used cautiously in patients with asthma, COPD, diabetes, or peripheral vascular disease.
- The most recent study from 2022 1 highlights the importance of considering beta-blocker treatment in patients with hypertension and concomitant diseases, and provides guidance on the use of beta blockers in various clinical scenarios.
Benefits and Risks
- Benefits: Beta blockers have been shown to reduce morbidity and mortality in patients with hypertension and concomitant diseases, improve quality of life, and provide cardiovascular prevention when used in combination with other cardiovascular drugs.
- Risks: Beta blockers can cause side effects such as fatigue, dizziness, cold extremities, and sleep disturbances, and should be used cautiously in patients with certain comorbidities, such as asthma, COPD, diabetes, or peripheral vascular disease.
Clinical Implications
- Beta blockers should be considered as a first-line treatment for patients with hypertension, especially those with concomitant diseases and conditions that benefit from beta-blocker treatment.
- The choice of beta blocker should be individualized based on the patient's specific condition and comorbidities.
- Patients should be monitored for potential side effects and beta blockers should be used cautiously in patients with certain comorbidities.
- The most recent study from 2022 1 provides guidance on the use of beta blockers in various clinical scenarios and highlights the importance of considering beta-blocker treatment in patients with hypertension and concomitant diseases.
From the FDA Drug Label
In the presence of AV block, beta-blockade may prevent the necessary facilitating effect of sympathetic activity on conduction. Beta2-adrenergic blockade results in passive bronchial constriction by interfering with endogenous adrenergic bronchodilator activity in patients subject to bronchospasm and may also interfere with exogenous bronchodilators in such patients Nonallergic Bronchospasm (e.g., Chronic Bronchitis, Emphysema): In general, patients with bronchospastic lung disease should not receive beta-blockers. Beta-adrenergic blockade may prevent the appearance of certain premonitory signs and symptoms (pulse rate and pressure changes) of acute hypoglycemia, especially in labile insulin-dependent diabetics.
Beta blockers can have various effects on the body, including:
- Conduction: Beta-blockade may prevent the necessary facilitating effect of sympathetic activity on conduction in patients with AV block 2.
- Bronchial constriction: Beta2-adrenergic blockade can cause passive bronchial constriction, interfering with endogenous adrenergic bronchodilator activity in patients with bronchospasm 3.
- Hypoglycemia: Beta-adrenergic blockade may prevent the appearance of certain premonitory signs and symptoms of acute hypoglycemia, especially in labile insulin-dependent diabetics 2.
- Contraindications: Patients with bronchospastic lung disease should not receive beta-blockers 2.
From the Research
Beta Blockers Overview
- Beta blockers refer to a mixed group of drugs with diverse pharmacodynamic and pharmacokinetic properties 4
- They have shown long-term beneficial effects on mortality and cardiovascular disease (CVD) when used in people with heart failure or acute myocardial infarction 4
Effects on Hypertension
- The benefit of beta blockers as first-line therapy for hypertension without compelling indications is controversial 4
- Beta blockers were found to have no difference in all-cause mortality compared to placebo, diuretics, or renin-angiotensin system (RAS) inhibitors, but had higher mortality compared to calcium-channel blockers (CCBs) 4
- Total CVD was lower for beta blockers compared to placebo, but the effect of beta blockers on CVD was worse than that of CCBs 4
Effects on Heart Failure
- Beta blockers have become the cornerstone in the treatment of systolic heart failure, alongside ACE-inhibitors 5
- Bisoprolol, metoprolol, and carvedilol have reduced all-cause death by 34-5% in patients with systolic heart failure 5
- The main mode of action of beta blockers in treating systolic heart failure is inhibition of chronic beta-1 stimulation-induced myocardial apoptosis/necrosis/inflammation 5
Comparison of Beta Blockers
- The choice of beta blocker is important, as benefit is not a class-effect 5
- Bisoprolol, metoprolol succinate, and carvedilol are considered to have optimal efficacy, while beta blockers with intrinsic sympathomimetic activity (ISA) have diminished efficacy 5
- A study comparing bisoprolol, carvedilol, and metoprolol succinate found similar effects on mortality amongst patients with chronic heart failure 6
Adverse Effects
- Beta blockers can cause adverse effects such as metabolic disturbance, bronchospasm, epinephrine/hypertensive interaction, and sexual dysfunction 5
- Lipophilic beta blockers like propranolol and metoprolol can cause side effects such as insomnia, dreams, and nightmares 5