What is the comparison between Beta (beta) blockers and Calcium Channel (CCB) blockers?

From the Guidelines

Beta blockers and calcium channel blockers (CCBs) are both effective for hypertension, but the choice between them should be based on individual patient characteristics and comorbidities, with CCBs being a better option for patients with multiple metabolic risk factors or those of African descent, as suggested by the 2012 European guidelines on cardiovascular disease prevention in clinical practice 1. When considering the use of beta blockers versus CCBs, it's essential to weigh their respective benefits and drawbacks. Beta blockers, such as metoprolol, carvedilol, and atenolol, are particularly useful for conditions like hypertension, angina, heart failure, and post-myocardial infarction care, with metoprolol typically starting at 25-50mg twice daily and titrated as needed. On the other hand, CCBs, including amlodipine, diltiazem, and verapamil, are effective for hypertension, angina, and certain arrhythmias, with amlodipine typically started at 5mg daily.

Some key differences between the two classes include:

• Beta blockers may cause fatigue, sexual dysfunction, and mask hypoglycemia symptoms, while CCBs can cause peripheral edema and constipation.
• CCBs may be better for elderly patients, those with asthma/COPD, or patients of African descent.
• Beta blockers are preferred for patients with heart failure, prior heart attacks, or anxiety symptoms. The 2018 systematic review for the ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults also highlights the importance of considering individual patient characteristics when choosing between antihypertensive therapies 1. Ultimately, the decision between beta blockers and CCBs should be based on a thorough evaluation of the patient's specific needs and medical history.

From the FDA Drug Label

Amlodipine is a peripheral arterial vasodilator that acts directly on vascular smooth muscle to cause a reduction in peripheral vascular resistance and reduction in blood pressure Metoprolol is a beta 1-selective (cardioselective) adrenergic receptor blocker. In clinical studies in which amlodipine was administered in combination with beta-blockers to patients with either hypertension or angina, no adverse effects on electrocardiographic parameters were observed.

Comparison of Beta Blockers and CCB:

• Mechanism of Action: Amlodipine acts as a peripheral arterial vasodilator, while metoprolol acts as a beta 1-selective adrenergic receptor blocker.
• Effects on Heart Rate and Blood Pressure: Amlodipine reduces blood pressure by decreasing peripheral vascular resistance, while metoprolol reduces heart rate and blood pressure by blocking beta 1-adrenergic receptors.
• Combination Therapy: Amlodipine and beta-blockers can be used together without adverse effects on electrocardiographic parameters.
• Key Differences:
  • Amlodipine is a calcium channel blocker, while metoprolol is a beta-blocker.
  • Amlodipine has a longer half-life (30-50 hours) compared to metoprolol (3-4 hours).
  • Amlodipine is extensively metabolized by the liver, while metoprolol is primarily metabolized by CYP2D6. 2 3

From the Research

Comparison of Beta Blockers and CCB

• Beta blockers and calcium channel blockers (CCBs) are both used to treat hypertension, but they have different mechanisms of action and effects on the body 4, 5, 6.
• Beta blockers work by blocking the effects of the hormone epinephrine, also known as adrenaline, and reducing the heart rate and blood pressure 5, 6.
• CCBs, on the other hand, work by blocking the entry of calcium into the muscle cells of the heart and blood vessels, leading to a decrease in blood pressure 4.

Efficacy of Beta Blockers

• Some studies have suggested that beta blockers may not be as effective as other antihypertensive agents, such as CCBs, in reducing blood pressure and cardiovascular outcomes 7, 8.
• However, other studies have found that beta blockers can be effective in reducing blood pressure and cardiovascular risk, particularly in certain patient populations, such as those with heart failure or ischemic heart disease 4, 5.
• The European Society of Hypertension (ESH) guideline recommends that beta blockers can be used as first-line therapy for hypertension, particularly in patients with certain compelling indications, such as heart failure or ischemic heart disease 4.

Differences between Beta Blockers

• Not all beta blockers are the same, and they can differ in their pharmacologic properties, such as their degree of intrinsic sympathomimetic activity, membrane stabilizing activity, and beta1 selectivity 5, 6.
• Some beta blockers, such as carvedilol and labetalol, have additional properties, such as alpha1-adrenergic blocking effects, that can provide additional benefits in certain patient populations 6.
• The choice of beta blocker should be individualized based on the patient's specific needs and medical history 5, 6.

Patient-Specific Considerations

• The choice between beta blockers and CCBs should be based on the individual patient's needs and medical history, including the presence of compelling indications, such as heart failure or ischemic heart disease 4, 5.
• In young and middle-aged patients, non-vasodilating beta blockers may be preferred as first-line therapy, while in elderly patients, vasodilating beta blockers may be more appropriate due to their favorable hemodynamic profile 8.