The short answer... yes, but...
Although beta blockers can work to lower high blood pressure (HBP or hypertension), they are not typically a first-choice treatment. Beta blockers lower blood pressure by slowing the heartbeat and giving the heart time to relax in between contractions.
What they don’t do is cut your risk of stroke, one of the very real and very serious risks of high blood pressure. Because of this, they are only prescribed if there is another benefit from them. That might be if you get angina (chest pain), or have a fast and irregular heartbeat. Beta blockers are also good if you’ve recently had a heart attack that affects how your heart pumps or if you have heart failure (weakness of your heart muscle).
Table of contents
Why trust us
Dr. Purva Singla is a pharmacist (PharmD) licensed in Illinois. She has worked in Medical Affairs at a pharmacy benefits management company and as a medical communications specialist in the pharmaceutical industry. Purva brings over 10 years of experience helping people make good health decisions by means of medical and wellness education.
A
The research is strong. Many studies confirm this.
What is high blood pressure and who should care?
High blood pressure (HBP) is common in the United States. In 2019, the American Heart Association reported that nearly half of all American adults have high blood pressure.
But what is high blood pressure? And who needs to be aware of it? High blood pressure is when the pressure in your blood vessels is frequently higher than normal. It tends to run in families. Depending on the cause it can affect people of any age, but it’s more common in older folks. It’s also more common in people:
Who are black
With diabetes
With kidney disease
Who are overweight or obese
Who drink too much alcohol
Around 17% of of US adults don't know they have HBP. This is a problem because over time, untreated HBP can lead to:
Heart disease
Stroke
Kidney failure
Eye damage
Death
Across the US population as a whole, it has been estimated that lowering the top BP number (systolic BP) by just 5 mmHg would lower deaths from strokes by 14%, heart disease deaths by 9%, and all-cause deaths by 7%.
There are many treatments available for HBP. If you know other people with high blood pressure, it might seem like everyone is taking a different drug for their condition. Here we’ll explain beta blockers and when they are useful in treating HBP.
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The complete answer
What are beta blockers and how do they work?
Beta blockers are a class of drugs that are used to treat many conditions including:
High blood pressure
Heart failure
Chest pain
Heart attacks
Irregular heart rhythms
Migraines
Glaucoma
Tremors
Symptoms of overactive thyroid
The name “beta blockers” comes from the fact that this medication blocks the effects of the hormone adrenaline on beta-receptors in your heart. This allows your heart to beat more slowly and with less force, relieving stress on the heart and lowering blood pressure.
Why aren’t beta blockers a first choice for treating high blood pressure?
Beta blockers are not the first choice for lowering HBP. They can lower blood pressure just as well as first-choice medications. But what they don’t do well
for many people is lower the risk of serious complications of HBP like strokes, heart attacks, and even death.
Much better for reducing this risk are other drugs including:
angiotensin converting enzyme inhibitors (ACE-I)
angiotensin II receptor blockers (ARB)
thiazide diuretics and calcium channel blockers (CCB)
These medications are especially
good for black people and people over the age of 60, whose HBP is sometimes harder to treat. Ethnicity and age factor into how doctors decide on the right blood pressure medication.
The fact that beta blockers on their own are not ideal for lowering HBP and protecting against strokes and heart attacks doesn’t mean they shouldn’t be used in the treatment of HBP. There are certain situations where beta blockers are helpful. In these cases a combination of beta blockers with other first-choice
HBP drugs can work well.
Side effects of beta blockers
Aside from beta blockers not being great for lowering HBP, there is another reason to try other medications first: their side effects.
Blood Sugar Changes
In the past, doctors thought it wasn’t a good idea to take a beta blocker for hypertension if you had or were at risk for diabetes. For some people, taking a traditional beta blocker led
to less control of blood sugar levels. And in some cases, for people with HBP who were otherwise healthy, taking a beta blocker increased their chances of developing diabetes.
So what happens if you have diabetes and HBP, but you have to take a beta blocker for another medical reason? The good news is that the newer beta blockers on the market, like carvedilol and nebivolol, don’t affect blood sugar like the traditional beta blockers.
That being said, your doctor will likely talk to you about the risk of beta blockers masking the signs of hypoglycemia (dangerously low blood sugar). If you have diabetes, you know how important it is to spot signs of hypoglycemia so you can act quickly to treat it. For example, a fast heart rate, tremor (shaking of the hands or feet) or nervousness can all be signals of hypoglycemia. Beta blockers tend to hide these signs because they slow the heart rate and decrease your body’s physical reaction to stress (your fight-or-flight response). So, while it’s perfectly okay to take a beta blocker if you have diabetes, it's also important to follow your doctor’s advice on how to keep your blood sugar at safe levels.
Dangerous Slowing of the Heart
Beta blockers slow the signals that control your heartbeat. This can be very useful when you have a fast heart beat. But if you don’t, taking a beta blocker can slow your heart rate dangerously and the heart
can even skip beats (not in a good way). Some people are more at risk of this than others. This includes people who have had heart rate or rhythm problems before or are taking other medication that can slow the heart down. Knowing this, doctors are careful about prescribing beta blockers to people who are already at risk for a slow heart rate.
Worsening Asthma Symptoms
Beta blockers were once off-limits for people with asthma. This is because some
beta blockers can irritate the lungs, making it a little harder to breathe. But most doctors feel the benefits of lowering your blood pressure are more important than the small chance of your asthma worsening. If a beta blocker is a must for your HBP, there are specific ones that won’t stress the lungs. These are cardioselective beta blockers like bisoprolol, metoprolol, and atenolol. That means they work more on the heart and less on other parts of the body like the lungs.
So who are beta blockers good for?
A beta blocker is the drug of choice for people who have HBP along with any of the following conditions.
Heart failure: When your heart muscle doesn't pump blood as well as it should
Coronary artery disease: When cholesterol clogs up the blood vessels that supply the heart, causing chest pain and heart attacks
Atrial fibrillation: A fast and irregular heart beat
Pregnancy
In these situations, your doctor will often prescribe a particular beta blocker along with your HBP medication. You’ll still need the “first-choice” HBP medication to lower your risk of stroke and heart attack. Different beta blockers are recommended in different situations. We’ll run through these here.
Heart Failure
In patients with heart failure, adding a beta blocker increases the chance of living a longer life. Lowering blood pressure with a beta blocker puts less stress on the heart and reduces heart failure symptoms.
Common beta blockers for heart failure: carvedilol, metoprolol succinate, bisoprolol.
Coronary Artery Disease (CAD)
Taking a beta blocker if you have CAD will help to prevent chest pain and heart attacks. Beta blockers relax the blood vessels, lowering blood pressure and slowing the heart rate. This allows more oxygen and blood to fill the heart muscle, improving chest pain and the risk of a heart attack. If you’ve had a
recent heart attack, your doctor will most likely prescribe a beta blocker as it has been shown to lower your risk for another heart attack by about 25%.
Common beta blockers for CAD: carvedilol, metoprolol tartrate, metoprolol succinate, nadolol, bisoprolol, propranolol, and timolol.
Pregnancy
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sudden increase in blood pressure during pregnancy or afterwards can increase the chance of stroke and heart failure, and it puts mom and baby in danger. A beta blocker called labetalol is one of the safest blood-pressure-lowering medications to use in pregnancy. It works well to lower blood pressure fast in pregnancy emergencies.
Common beta blockers for pregnancy: labetalol
How we decided
To answer this question, we dug deep into the current scientific evidence on how well beta blockers work for treating high blood pressure (HBP), especially in comparison to other blood-pressure-lowering medications.
The evidence we reviewed is powerful and trustworthy. It was written and reviewed by experts in this field and includes:
Randomized controlled trials (the best kind of trials that exist)
Landmark clinical trials
Cochrane reviews
Meta-analyses (summaries of important clinical trials)
National statistics from respected professional and clinical groups
National guidelines on the treatment of high blood pressure and coronary heart disease
Guidelines are a summary package of the most dependable information researched by experts, to be used by clinicians. We looked at guidelines from the:
American Society of Hypertension
International Society of Hypertension
American Heart Association
American College of Cardiology
American Society of Hypertension
Here is a summary of the evidence reviewed.
Thirteen studies totalling almost 100,000 people between the 1970s and 2016 were reviewed by Cochrane in 2017. These studies included 40,245 people taking beta blockers, all of them on older beta blockers like atenolol. In these studies, beta blockers were compared to placebo, diuretics (water pills), calcium channel blockers (CCBs), ACE inhibitors, and ARBs (angiotensin receptor blockers).
Though the studies did not include any newer beta blockers, researchers noticed the following trends.
Beta blockers did not decrease the number of deaths among people with HBP.
Beta blockers may lower the chance of stroke in people with HBP, but not nearly as well as CCBs, ACE inhibitors, or ARBs.
Beta blockers made little or no difference in lowering the risk of heart attack in people with HBP.
People taking beta blockers were more likely to get side effects and stop taking their medications than people on ACE inhibitors and ARBs.
A 2006 meta-analysis looked more specifically at how beta blockers work in younger people versus older people up to age 60. The results were interesting: Older people taking beta blockers were at a higher risk of stroke, heart attack, and death than those taking other BP medications. The risk was particularly high for stroke.
An older MRC Working Party trial study from 1992 was one of the first to establish this link: beta blockers did not lower the risk of stroke, heart attack, or death in older people with HBP, while diuretics did.
A 2009 meta-analysis of 147 clinical trials between 1966 and 2007 also backed the finding that beta blockers are less effective in preventing stroke, heart attack, and death than other classes of HBP medications. But, when a beta blocker is used together with another medication, the combination fares as well as other drug combos.
The study shed more light on two particular groups of people for whom beta blockers do have a special protective effect:
People with a history of heart disease or who have recently had a
heart attack.
People with heart failure.
Several landmark (important and impactful) trials have shown how important it is for patients with heart failure and HBP to use beta blockers. These studies include the:
MERIT-HF
COPERNICUS
CIBIS-II
Finally, there were two key guidelines we reviewed that explained in detail why and in what situations certain beta blockers are recommended for people with HBP. The guidelines summarized findings from trustworthy clinical trials on beta blockers and other blood pressure lowering drug classes.
The 2017 ACC/AHA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults
Treatment of Hypertension in Patients With Coronary Artery Disease
Keep in mind
It's worth mentioning that much of the research on beta blockers is based on one beta blocker called atenolol. There are newer beta blockers that are more specific in their actions on the heart. Different beta blockers have special qualities or side effects that can make them a better choice depending on your medical history, age, and ethnicity.
For instance, research on the effect of beta blockers on blood sugar levels in people with diabetes is constantly growing and getting better. A lot of this is because of the newer vasodilating and cardioselective beta blockers. The list of reviews and clinical trials below will help you understand when it might be good for a person with diabetes to take a beta blocker for their HBP. It is generally perfectly safe to take a beta blocker, as long as you monitor blood sugar levels carefully.
Casiglia, E.
Bakris, G.L.
Sarafidis, P.
Other choices
What are my choices of treatments for lowering blood pressure besides beta blockers?
The choices of HBP medications are seemingly endless. So how do you know which one is best for you? While the answer to this question is different for everyone, there are standard drug classes prescribed to patients with HBP. Let’s review the recommended drug classes doctors start with. Keep in mind that this is not an all-inclusive list. Selecting the right drug or combination treatment will depend on your medical history, age, ethnicity, or unique health situation.
These drug classes not only lower blood pressure but they also prevent future problems related to HBP like heart disease, stroke, and death.
Are there any medication-free choices to lower blood pressure?
Yes. Your healthcare provider will likely suggest adjustments to lifestyle habits that might be making your HBP worse. They will ask you to start an exercise plan to lose extra weight you may be carrying. Or your doctor may suggest limiting alcohol, cutting out smoking, and to think about your food choices like caffeine and salt, which can affect your blood pressure numbers.
What's ahead
It is unlikely that newer or future generations of beta blockers will change the way that blood pressure is treated. Beta blockers will probably always be a second-choice medication when it comes to lowering HBP, unless there is a specific need for them, such as heart failure, or coronary artery disease.
Luckily, new BP treatments are emerging all the time. One such medication is a new combination pill under the name Entresto which combines a new class of medication sacubitril with the ARB valsartan. A recent clinical trial compared it against a placebo (sugar pill) or another ARB and the results showed that it works well to lower high blood pressure. More studies are needed to see if this combination helps improve survival and reduce the risks of heart disease and stroke.
References
Best study we found
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American Diabetes Association. (2019). Glycemic Targets: Standards of Medical Care in Diabetes. Diabetes Care. 42(1):S61-S70.
Bakris G.L., Fonseca V., Katholi R.E., et al. (2004). Metabolic effects of carvedilol vs metoprolol in patients with type 2 diabetes mellitus and hypertension: a randomized controlled trial. Journal of the American Medical Association. 292(18):2227-2236.
Benjamin E.J., Muntner P., Alonso A., et al. (2019). Heart Disease and Stroke Statistics— 2019 update: a report from the American Heart Association. Circulation. 139(10):e56-e528.
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CIBIS-II Investigators and Committees. (1999). The Cardiac Insufficiency Bisoprolol Study II (CIBIS-II): a randomised trial. Lancet. 353(9146):9-13.
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