Beta Blockers and Circadian Rhythm

Introduction to Beta Blockers

• Beta blockers are the most effective drug class for rate control, achieving heart rate endpoints in 70% of patients 1
• The American College of Cardiology recommends considering atenolol for its hydrophilic properties and once-daily dosing when circadian rhythm concerns exist 2

Properties of Beta Blockers

• Hydrophilic beta blockers, such as atenolol, have limited penetration into the brain and are less likely to disrupt sleep patterns and circadian rhythm 2
• Lipophilic beta blockers, such as propranolol, readily cross the blood-brain barrier and have a higher incidence of sleep disturbances and dreams 2

Selecting Beta Blockers for Minimal Impact on Circadian Rhythm

• The American College of Cardiology suggests choosing hydrophilic agents like atenolol when concerned about sleep disturbances, and avoiding highly lipophilic agents like propranolol in patients reporting sleep issues 2
• Consideration of timing of administration, such as morning dosing, may minimize sleep disruption 2

Side Effects and Considerations

• Several beta blockers are associated with weight gain, which could exacerbate conditions like obstructive sleep apnea, according to the British Journal of Pharmacology 3