Beta-Blocker Safety and Angioedema

Side Effects of Beta-Blockers

• The European Society of Cardiology notes that beta-blockers are associated with cold extremities, related to peripheral vasoconstriction 2
• The European Society of Cardiology reports that beta-blockers can cause symptomatic bradycardia, from cardiac rate reduction 1
• The European Society of Cardiology states that beta-blockers can increase respiratory symptoms in asthma/COPD, less common with beta-1 selective agents 2
• The European Society of Cardiology indicates that beta-blockers can cause fatigue, occurring in only 0.4% of patients 3
• The European Society of Cardiology warns that beta-blockers can cause conduction disturbances when combined with heart rate-lowering calcium channel blockers 1

Angioedema Association

• The American College of Cardiology recommends that angioedema in cardiovascular medicine is specifically associated with medications that affect the bradykinin pathway, such as ACE inhibitors 4
• The American Heart Association notes that ACE inhibitors occur in <1% of patients, but more frequently in Black patients and women 5
• The American College of Cardiology states that ACE inhibitors result from defective degradation of bradykinin, des-Arg9-BK, and substance P 8
• The American College of Cardiology advises that ACE inhibitors are an absolute contraindication to continue or rechallenge if angioedema occurs 5
• The American Heart Association reports that Angiotensin Receptor Blockers (ARBs) have a much lower incidence of angioedema compared to ACE inhibitors 7
• The American College of Cardiology warns that Neprilysin Inhibitors have a high risk when combined with ACE inhibitors due to dual inhibition of bradykinin breakdown 4
• The American College of Cardiology recommends that beta-blockers remain Class I, Level A recommendations for heart failure with reduced ejection fraction to reduce mortality and hospitalizations 4