Beta Blockers Used for High Blood Pressure
The beta blockers recommended for hypertension treatment include carvedilol, metoprolol tartrate, metoprolol succinate, nadolol, bisoprolol, propranolol, and timolol. 1
Recommended Beta Blockers for Hypertension
First-line Beta Blockers
- Carvedilol (12.5-50 mg twice daily or 20-80 mg once daily for phosphate form) - combined alpha and beta receptor blocker, preferred in patients with heart failure with reduced ejection fraction 1
- Metoprolol tartrate (100-200 mg twice daily) - cardioselective beta blocker 1
- Metoprolol succinate (50-200 mg once daily) - cardioselective beta blocker, preferred in patients with heart failure with reduced ejection fraction 1
- Bisoprolol (2.5-10 mg once daily) - cardioselective beta blocker, preferred in patients with heart failure 1
- Nadolol (40-120 mg once daily) - noncardioselective beta blocker 1, 2
- Propranolol (80-160 mg twice daily for immediate release; 80-160 mg once daily for long-acting) - noncardioselective beta blocker 1
- Timolol - noncardioselective beta blocker 1
Other Beta Blockers Used for Hypertension
- Nebivolol (5-40 mg once daily) - cardioselective with vasodilatory properties through nitric oxide induction 1, 3
- Labetalol (200-800 mg twice daily) - combined alpha and beta receptor blocker 1, 4
- Acebutolol (200-800 mg twice daily) - cardioselective with intrinsic sympathomimetic activity 1
- Betaxolol (5-20 mg once daily) - cardioselective 1
- Penbutolol (10-40 mg once daily) - with intrinsic sympathomimetic activity 1
- Pindolol (10-60 mg twice daily) - with intrinsic sympathomimetic activity 1
Beta Blockers to Avoid or Use with Caution
- Atenolol (25-100 mg twice daily) - should not be used as it is less effective than placebo in reducing cardiovascular events 1, 5
- Beta blockers with intrinsic sympathomimetic activity (acebutolol, penbutolol, pindolol) - generally should be avoided, especially in patients with ischemic heart disease or heart failure 1
Specific Indications for Beta Blockers in Hypertension
Beta blockers are particularly useful in hypertensive patients with:
- Stable ischemic heart disease or angina pectoris 1
- Previous myocardial infarction 1
- Heart failure with reduced ejection fraction 1
- Tachyarrhythmias (both ventricular and supraventricular) 1, 6
- Migraine prevention (metoprolol, propranolol, timolol) 1
- Essential tremor (propranolol, metoprolol) 1
- Hyperthyroidism 1
- Anxiety disorders 1
Combination Therapy
- Beta blockers are often combined with thiazide diuretics for enhanced blood pressure control 4, 7
- When used with dihydropyridine calcium channel blockers, beta blockers can provide additional antihypertensive effect and relieve angina 1, 5
- Avoid combining beta blockers with non-dihydropyridine calcium channel blockers (verapamil, diltiazem) in heart failure 1
- Beta blockers can be used with ACE inhibitors or ARBs in patients with heart failure or post-myocardial infarction 1
Common Pitfalls and Caveats
- Beta blockers are not recommended as first-line agents for uncomplicated hypertension unless specific indications exist 1, 6
- Avoid abrupt discontinuation of beta blockers, which can lead to rebound hypertension or exacerbation of angina 1, 2
- Monitor heart rate carefully, especially in elderly patients - excessive bradycardia can lead to adverse cardiovascular events 1
- Beta blockers were previously thought to be contraindicated in COPD and peripheral artery disease, but recent evidence suggests they may be safe and even beneficial in these conditions 1
- Beta blockers with vasodilatory properties (carvedilol, nebivolol) may have better metabolic profiles than traditional beta blockers 6, 3
- Cardioselective beta blockers (metoprolol, bisoprolol) are preferred in patients with reactive airway disease 1
By selecting the appropriate beta blocker based on patient-specific factors and comorbidities, these medications can be effective tools in managing hypertension while providing additional benefits for coexisting conditions.