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Hypertension, or high blood pressure, is one of the most common conditions for which people seek medical treatment. If not detected and treated appropriately, hypertension can greatly increase the risk of serious medical problems such as heart attack, stroke and kidney failure. It also increases the chances of an early death.[1]
A healthy lifestyle, including a low-salt diet rich in vegetables and fruits plus regular exercise, is critical for preventing or managing high blood...
Hypertension, or high blood pressure, is one of the most common conditions for which people seek medical treatment. If not detected and treated appropriately, hypertension can greatly increase the risk of serious medical problems such as heart attack, stroke and kidney failure. It also increases the chances of an early death.[1]
A healthy lifestyle, including a low-salt diet rich in vegetables and fruits plus regular exercise, is critical for preventing or managing high blood pressure.[2] Increased dietary potassium intake can also reduce the occurrence of hypertension, as discussed in the June 2015 issue of Worst Pills, Best Pills News. While these steps may be enough to control high blood pressure in some individuals, others will require drug treatment to achieve adequate control.[4]
| Nondrug Treatments of High Blood pressure |
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A healthy lifestyle is critical for the prevention of high blood pressure and is an essential part of its management. The following are some steps you can take that have been shown to lower high blood pressure:
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Beta blockers — a class of drugs including atenolol (TENORMIN), bisoprolol (available in generic only), carvedilol (COREG, COREG CR), metoprolol succinate (TOPROL XL), metoprolol tartrate (LOPRESSOR), nadolol (CORGARD) and propranolol (HEMANGEOL, INDERAL, INNOPRAN XL) — have long been a mainstay of hypertension drug treatment. Yet in recent years, studies have shown these drugs to be less effective than other antihypertensive drugs at preventing serious heart-related risks, particularly for older adults and smokers.
While these drugs remain useful for some patients, we now no longer recommend them as the starting treatment for hypertension except in special circumstances.
Stroke risks in older adults and smokers
Beta blockers work primarily by blocking the blood-pressure-raising effects of the hormone epinephrine (also known as adrenaline) on the heart and blood vessels.[5]
Beta blockers do not work as well as other antihypertensive drugs in preventing stroke, other cardiovascular events or death, especially among smokers and patients over age 60.[6],[7],[8] This reduced benefit was seen even in studies where the beta blockers alone were equally as effective, on average, at controlling blood pressure as other antihypertensive drugs.[9]
Serious side effects
In addition to being less effective than other antihypertensive drugs in preventing stroke and other serious complications of hypertension, beta blockers can also cause a number of serious side effects. These include:
- Diabetes. Beta blockers increase the risk of diabetes,[10] and they also increase the risk of heart-related illness and death in some patients with existing diabetes.[11] (However, carvedilol is better than other beta blockers at lowering blood pressure while also controlling blood sugar and preventing diabetic complications.[12])
- Impaired breathing. Beta blockers impair the ability of the passages in the lungs, called bronchi, to expand and take in air.[13] This can make these drugs dangerous for patients with severe lung conditions that lead to sudden restricted airflow, particularly asthma.[14]
- Potassium imbalance. Beta blockers rarely can cause a dangerous rise in blood potassium levels, a known as hyperkalemia.[15]
- Interaction with epinephrine (ADRENACLICK, ADRENALIN, AUVI-Q, EPIPEN). Beta blockers can block epinephrine when it is taken as an injection for allergic reactions.[16] This can make the epinephrine less effective.
- Fatal overdose. Overdoses of beta blockers can cause dangerously low heart rate and blood pressure and interfere with the pumping of the heart, leading to shock, convulsions, coma and death.[17]
Side effects related to breathing, potassium imbalance, and interaction with epinephrine can be mitigated by taking a “beta-1 selective” beta blocker, also referred to as a “cardioselective” beta blocker (these include atenolol, bisoprolol and metoprolol).[18] Nebivolol (BYSTOLIC, BYVALSON) is also often described and promoted as a beta-1 selective beta blocker, but this drug should not be used, as it actually loses its beta-1 selectivity at doses of 10 milligrams or more per day, well within the drug’s standard dosage range.[19]
When beta blockers can help
There are special circumstances under which treatment with certain beta blockers may be warranted. For patients with current or prior symptoms of systolic heart failure (heart failure in which the heart fails to pump normally) whose condition is stable, beta blockers have been shown in high-quality clinical trials to improve symptoms and lower mortality risk.[20] However, for patients with diastolic heart failure (in which the heart muscle fails to relax normally, but the heart still pumps normally), clinical trials have shown that beta blockers do not have special benefits.[21]
Beta blockers also benefit patients with angina, and those who have had a prior heart attack.[22] They are also helpful in controlling irregular heartbeat (atrial fibrillation or atrial flutter).[23]
Beta blockers have also been found to be useful in preventing complications when used two or more days prior to heart surgery.[24] However, these drugs are not helpful for other types of surgery and may even cause more harm overall, as reported in the August 2016 Worst Pills, Best Pills News article “Starting Beta Blockers Before Noncardiac Surgery May Be Harmful.”[25]
The final circumstance under which beta blockers might be helpful is in patients who have tried other antihypertensive drugs and failed to control their blood pressure. Many patients will respond well to one drug but not another, and the ultimate measure of whether any antihypertensive drug is right for any particular patient is whether it successfully controls that person’s blood pressure.[26]
Therefore, if you have tried other antihypertensive drugs and adding a beta blocker to your treatment regimen is the most effective way to control your blood pressure, you should continue with that treatment.
What You Can Do
Do not take a beta blocker unless you have one of the conditions discussed above, or unless you have tried other types of antihypertensive drugs and beta blockers work best for controlling your blood pressure.
If you have diabetes or are at risk for diabetes, have breathing problems, have problems with elevated blood potassium levels, or carry an epinephrine injector for allergies, you are at especially high risk of dangerous side effects from beta blockers. This risk can be mitigated by choosing carvedilol (for people with diabetes) or, for people with breathing problems, potassium issues, or need of an EPIPEN, a cardioselective beta blocker such as atenolol, bisoprolol or metoprolol.
If you are already taking a beta blocker and do not have one of the conditions listed above, talk with your doctor about slowly transitioning to another antihypertensive medication. Never stop taking your beta blocker abruptly, as this can lead to deadly side effects, particularly in patients with coronary artery disease. To mitigate this risk, you should work closely with a doctor to gradually taper down the dose.
References
[1] James PA, Oparil S, Carter BL, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: Report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311(5):507-520.
[2] High blood pressure. WorstPills.org. /chapters/view/41. Accessed November 16, 2016.
[3] More dietary potassium can reduce occurrence of hypertension, amount of drugs needed for its treatment. Worst Pills, Best Pills News. June 2015. /newsletters/view/969. Accessed December 20, 2016.
[4] High blood pressure. WorstPills.org. /chapters/view/41. Accessed November 16, 2016.
[5] Mayo Clinic. High blood pressure (hypertension): Beta blockers. September 09, 2016. http://www.mayoclinic.org/diseases-conditions/high-blood-pressure/in-depth/beta-blockers/art-20044522. Accessed November 14, 2016.
[6] Wiysonge CS, Bradley HA, Volmink J, et al. Beta-blockers for hypertension. Cochrane Database Syst Rev. 2012;11:CD002003.
[7] MRC Working Party. Medical Research Council trial of treatment of hypertension in older adults: Principal results. BMJ. 1992;304(6824):405http://cms.citizen.org/admin/worstpills/index.cfm.
[8] Khan N, McAlister FA. Re-examining the efficacy of beta-blockers for the treatment of hypertension: A meta-analysis. CMAJ. 2006;174(12):1737.
[9] Carlberg B, Samuelsson O, Lindholm LH. Atenolol in hypertension: Is it a wise choice? Lancet. 2004;364(9446):1684.
[10] Messerli FH, Bangalore S, Julius S. Risk/benefit assessment of beta-blockers and diuretics precludes their use for first-line therapy in hypertension. Circulation. 2008;117(20):2706.
[11] Lindholm LH, Ibsen H, Dahlöf B, et al. Cardiovascular morbidity and mortality in patients with diabetes in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): A randomised trial against atenolol. Lancet. 2002;359(9311):1004.
[12] Bakris GL. Treatment of hypertension in patients with diabetes mellitus. October 2016. www.uptodate.com. Accessed November 10, 2016.
[13] Podrid PJ. Major side effects of beta blockers. October 2016. UptoDate. Accessed November 9, 2016.
[14] Ibid.
[15] Ibid.
[16] People on certain beta blockers should be wary of epinephrine. Worst Pills, Best Pills News. May 2009. /newsletters/view/636. Accessed November 14, 2016.
[17] Podrid PJ. Major side effects of beta blockers. October 2016. UptoDate. Accessed November 9, 2016.
[18] People on certain beta blockers should be wary of epinephrine. Worst Pills, Best Pills News. May 2009. /newsletters/view/636. Accessed November 14, 2016.
[19] New hypertension drug poses breathing risks. Worst Pills, Best Pills News. May 2013. /newsletters/view/849. Accessed November 15, 2016.
[20] Colucci WS. Use of beta blockers in heart failure with reduced ejection fraction. UptoDate. Accessed November 9, 2016.
[21] Borlaug BA, Colucci WS. Treatment and prognosis of heart failure with preserved ejection fraction. UptoDate. Accessed November 14, 2016.
[22] Mann J. Choice of drug therapy in primary (essential) hypertension. UptoDate. October 2016. Accessed November 9, 2016.
[23] Ibid.
[24] Starting beta blockers before noncardiac surgery may be harmful. Worst Pills, Best Pills News. August 2016. /newsletters/view/1048.
[25] Ibid.
[26] Mann J. Choice of drug therapy in primary (essential) hypertension. UptoDate. Accessed November 9, 2016.
