Beta Blockers for Hypertension Treatment

Recommended Beta Blockers

The American College of Cardiology recommends carvedilol (12.5-50 mg twice daily or 20-80 mg once daily for phosphate form) as a combined alpha and beta receptor blocker, preferred in patients with heart failure with reduced ejection fraction 1, 2
The American College of Cardiology recommends metoprolol tartrate (100-200 mg twice daily) as a cardioselective beta blocker 2
The American College of Cardiology recommends metoprolol succinate (50-200 mg once daily) as a cardioselective beta blocker, preferred in patients with heart failure with reduced ejection fraction 1, 2
The American College of Cardiology recommends bisoprolol (2.5-10 mg once daily) as a cardioselective beta blocker, preferred in patients with heart failure 2, 3
The American College of Cardiology recommends nadolol (40-120 mg once daily) as a noncardioselective beta blocker 1, 2
The American College of Cardiology recommends propranolol (80-160 mg twice daily for immediate release; 80-160 mg once daily for long-acting) as a noncardioselective beta blocker 1, 2
The American College of Cardiology recommends timolol as a noncardioselective beta blocker 1

Atenolol (25-100 mg twice daily) should not be used as it is less effective than placebo in reducing cardiovascular events 1, 2, 4
Beta blockers with intrinsic sympathomimetic activity (acebutolol, penbutolol, pindolol) should generally be avoided, especially in patients with ischemic heart disease or heart failure 2

Beta blockers are particularly useful in hypertensive patients with stable ischemic heart disease or angina pectoris 1, 5
Beta blockers are particularly useful in hypertensive patients with previous myocardial infarction 1, 3
Beta blockers are particularly useful in hypertensive patients with heart failure with reduced ejection fraction 1, 3
Beta blockers are particularly useful in hypertensive patients with tachyarrhythmias (both ventricular and supraventricular) 5
Beta blockers are particularly useful in hypertensive patients with migraine prevention (metoprolol, propranolol, timolol) 6, 7
Beta blockers are particularly useful in hypertensive patients with essential tremor (propranolol, metoprolol) 6, 7
Beta blockers are particularly useful in hypertensive patients with hyperthyroidism 6, 7
Beta blockers are particularly useful in hypertensive patients with anxiety disorders 7

Beta blockers can be combined with thiazide diuretics for enhanced blood pressure control 1, 4
When used with dihydropyridine calcium channel blockers, beta blockers can provide additional antihypertensive effect and relieve angina 1, 4
Avoid combining beta blockers with non-dihydropyridine calcium channel blockers (verapamil, diltiazem) in heart failure 3
Beta blockers can be used with ACE inhibitors or ARBs in patients with heart failure or post-myocardial infarction 3

Beta blockers are not recommended as first-line agents for uncomplicated hypertension unless specific indications exist 2
Avoid abrupt discontinuation of beta blockers, which can lead to rebound hypertension or exacerbation of angina 2
Monitor heart rate carefully, especially in elderly patients - excessive bradycardia can lead to adverse cardiovascular events 7
Beta blockers may be safe and even beneficial in patients with COPD and peripheral artery disease 5, 8
Cardioselective beta blockers (metoprolol, bisoprolol) are preferred in patients with reactive airway disease 2