Is propranolol (beta blocker) effective for treating palpitations and hypertension?

From the Guidelines

Propranolol is a recommended treatment for patients with palpitations and high blood pressure, due to its ability to slow heart rate, reduce the force of heart contractions, and lower blood pressure, as evidenced by studies such as 1 and 1.

Key Points to Consider

• The typical starting dose for palpitations is 10-20 mg taken three times daily, which can be increased gradually if needed, as seen in the management of hypertrophic cardiomyopathy 1.
• For high blood pressure, the usual starting dose is 40 mg twice daily, potentially increasing to 120-240 mg per day divided into doses, with the goal of mitigating symptoms and limiting latent outflow gradients provoked during exercise 1.
• Propranolol works by blocking beta receptors in the heart, which not only slows heart rate and reduces the force of heart contractions but also lowers blood pressure, making it particularly useful for people experiencing both palpitations and hypertension.
• Side effects may include fatigue, cold extremities, sleep disturbances, and occasionally breathing difficulties in those with asthma or COPD, highlighting the need for careful patient selection and monitoring 1.
• It's crucial that propranolol not be stopped suddenly, as this can worsen symptoms; instead, dosage should be tapered gradually under medical supervision, and regular monitoring of heart rate and blood pressure is important while taking this medication.
• Propranolol may interact with certain medications, including some antidepressants, other blood pressure medications, and some diabetes medications, so it's essential to inform your doctor about all medications you're taking, as suggested by the concept of individualized beta-blocker treatment for high blood pressure dictated by medical comorbidities 1.

Clinical Considerations

• The selection of propranolol as a treatment option should consider the patient's overall clinical profile, including the presence of any comorbidities that might influence the efficacy or safety of the medication, as indicated by the principles outlined in 1.
• Regular follow-up is necessary to adjust the dosage as needed and to monitor for any potential side effects or interactions, ensuring that the treatment remains effective and safe for the patient.
• The use of propranolol for palpitations and high blood pressure is supported by its long-standing use in clinical practice, as well as by guidelines and expert consensus documents, such as those referenced in 1 and 1, which provide a framework for its application in managing these conditions.

From the FDA Drug Label

PHARMACODYNAMICS AND CLINICAL EFFECTS Hypertension: In a retrospective, uncontrolled study, 107 patients with diastolic blood pressure 110 to 150 mmHg received propranolol 120 mg t.i. d. for at least 6 months, in addition to diuretics and potassium, but with no other hypertensive agent. Propranolol contributed to control of diastolic blood pressure, but the magnitude of the effect of propranolol on blood pressure cannot be ascertained Four double-blind, randomized, crossover studies were conducted in a total of 74 patients with mild or moderately severe hypertension treated with propranolol hydrochloride extended-release capsules 160 mg once daily or propranolol 160 mg given either once daily or in two 80 mg doses.

Propranolol can be used for high blood pressure (hypertension) and palpitations. The drug label shows that propranolol is effective in controlling diastolic blood pressure and pulse rate in patients with mild or moderately severe hypertension. Key points about propranolol for palpitations and high blood pressure include:

• Dose: 120 mg t.i.d. or 160 mg once daily
• Efficacy: Propranolol contributed to control of diastolic blood pressure
• Studies: Four double-blind, randomized, crossover studies and one retrospective, uncontrolled study support the use of propranolol for hypertension 2

From the Research

Propranolol for Palpitations and High Blood Pressure

• Propranolol is a beta-blocker that has been used to treat high blood pressure and palpitations 3, 4.
• A study from 1969 found that propranolol was at least as potent as other antihypertensive drugs, such as bethanidine, guanethidine, and methyldopa, in treating hypertension 4.
• Propranolol reduces cardiac output and may also act by reducing the cardiac component of pressor stimuli, resulting in a gradual regulation of blood pressure at a lower level 4.
• However, propranolol is contraindicated in patients with obstructive airways disease or uncompensated heart failure 4.

Comparison with Other Beta-Blockers

• A study from 2008 compared the efficacy of atenolol and metoprolol succinate in controlling 24-hour blood pressure and found that metoprolol succinate was more effective in sustaining 24-hour and early morning blood pressure reductions 5.
• A meta-analysis from 2023 found that non-atenolol beta-blockers, including metoprolol, were effective in lowering blood pressure as add-on to monotherapy or as a component of combination antihypertensive therapy 6.
• The meta-analysis also found that metoprolol add-on or combination therapy had a significantly greater blood pressure reduction than non-beta-blocker therapy 6.

Clinical Use

• Propranolol and atenolol have been studied most intensely in hypertension, and propranolol has been found to be effective in controlling supine blood pressure 3, 4.
• Sotalol is probably the best antiarrhythmic among the beta-blockers, but propranolol may also be used to prevent sudden death in patients with arrhythmias 3.
• The use of individual beta-blockers, including propranolol, should follow the results of clinical trials and be based on the specific clinical situation 3.