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Beta Blockers Might Not Be Good First Line Therapy For High Blood Pressure

A new study in the Journal of the American College of Cardiology (August 14th issue by Bangalore et al.) questions the evidence behind using beta blockers as fist line therapy for high blood pressure.  It seems that these medications may actually increase the risk of stroke, especially in the elderly population.  The following drugs are all beta blockers:

  • Atenolol (Tenormin)
  • Metoprolol (Lopressor, Toprol-XL)
  • Propranolol (Inderal, Inderal LA)
  • Carvedilol (Coreg)

As many as 60 million Americans have high blood pressure, and many of them are currently taking beta blockers.  I asked Dr. Frank Smart, chairman of the department of cardiovascular medicine at Atlantic Health in New Jersey, what he thought of this new study.

1.  What is a beta

Beta blockers are a class of drugs that exert their effects on the heart by blocking the effects of adrenaline.  This results in a slower heart rate and reduced blood pressure.  They can also protect you from rhythm disturbances.

2.  What did this study show?

Beta blockers have a lot of important uses, but this analysis shows that they’re not as effective as (and may have more side effects than) other therapies for the treatment of high blood pressure.  In the past, we physicians thought, “Well, shucks, if beta blockers are good to use after a heart attack, and people with high blood pressure are at risk for having heart attacks, then maybe we should use a beta blocker to treat the blood pressure.”  This study contradicts this thinking, suggesting that the beta blockers are inferior to other therapies.  In other words, we should use beta blockers for the conditions that they’re known to be good for, but we should not infer that they are best for blood pressure management when there are better drugs available.

3.  Will the findings of this study
change your practice?

Yes they will.  I’m one of those people who have used beta blockers on occasion to treat high blood pressure in patients whom I thought were also at high risk for heart attack.  I probably won’t use beta blockers as first line treatment in those individuals anymore.  I’m going to stick with diuretics or renin-angiotensin system blockers.

4.  What do these findings mean for
people with high blood pressure?

It means that they should follow the guidelines indicated for the treatment of high blood pressure.  It involves a step-wise approach, with diuretics being that first step.  Any therapy is better than no therapy, and controlling high blood pressure is critically important, but beta blockers (as a monotherapy) are probably not as good as other treatments.

5.  When would you recommend the use of
beta blockers?

Beta blockers are a very important class of drugs for many cardiovascular diseases.  Anyone who’s had a  heart attack needs to be on a beta blocker, anyone who has congestive heart failure (CHF) and can tolerate a beta blocker should be on one, and hypertrophic cardiomyopathy requires treatment with beta blockers.  Beta blockers can control certain heart rhythm disturbances, and can reduce the risk of adverse cardiovascular events during surgery.

6.  What’s the take home message from
this study?

When treating high blood pressure, we should use drugs that have been shown to have the greatest reduction in mortality.  Don’t assume that the valuable effects of beta blockers (for people who’ve had heart attacks) automatically translate into benefits for people with high blood pressure.

Want to hear the full conversation?   Listen to the podcast with Dr. Smart

This post originally appeared on Dr. Val’s blog at

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One Response to “Beta Blockers Might Not Be Good First Line Therapy For High Blood Pressure”

  1. Dr. Scherger says:

    Great summary Val, and very practical.  Beta blockers should recede as first or second line treatment for high blood pressure.  Remember the diuretics!  They are great for first line, or second line in that they help all other drugs work better.  Beta blockers do save lives, after an MI, with CHF and cardiomyopathy, and with arrythmias.  They are great drugs when these targets are present.

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