Heart Advisor - When are beta blockers the right hypertension drug? Beta blockers are critical in conditions such as heart failure, but uncomplicated high blood pressure can…
Beta blockers, such as atenolol (Tenormin), metoprolol (Lopressor, Toprol-XL) and propranolol (Inderal, Inderal LA), certainly have their place in the fight to lower blood pressure–just not on the front lines.
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In cases of uncomplicated hypertension, other medications, such as diuretics, are preferable to beta blockers at protecting against stroke and heart attack, according to an analysis reported in the August 14 Journal of the American College of Cardiology (JACC).
However, hypertensive patients who have had heart attacks and who have congestive heart failure, are well-served by beta blockers, the study concludes.
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And according to research by Cleveland Clinic cardiologist like Sipahi, MD, published in the July 3 Annals of Internal Medicine, patients with coronary artery disease (CAD) could find beta blockers slowing or reversing the course of their condition.
“We found beta blockers actually slow down clogging of the coronary arteries,” Dr. Sipahi says. “This was completely novel information.” But Dr. Sipahi agrees that beta blockers, especially the popular atenolol, should not be first-line agents in patients without CAD.
“When there’s nothing to be cleared, beta blockers are not effective,” Dr. Sipahi says.
Other precautions/other options
The JACC report also notes that beta blockers should be prescribed with caution to elderly patients, because the drug’s ability to slow the heart rate could lead to fatigue, impotence and in less frequent occurrences, peripheral vascular problems.
But Dr. Sipahi disputes the degree to which peripheral vascular problems can be linked to beta blockers. He also suggests that some problems with fatigue diminish as your body gets used to the medication.
“With time, some of the side effects will subside,” Dr. Sipahi says. “That’s not always the case with impotence. In that case, you and your doctor may have to consider other options.”
Those options could include an alternate drug therapy program. For example, calcium channel blockers and angiotensin-converting enzyme (ACE) inhibitors proved to be a more effective combination for treating hypertension than beta-blockers and diuretics, according to results of another study, the 2005 Anglo-Scandinavian Cardiac Outcomes in the Blood Pressure Lowering Arm (ASCOT-BPLA) trial.
WHAT YOU CAN DO
* Ask your doctor about your drug options in treating high blood pressure, including diuretics, calcium channel blockers and ACE inhibitors.
* If you are taking a beta blocker, report all side effects, such as fatigue and impotence, to your doctor and discuss alternate treatments or dosages.
* Help yourself fight hypertension by losing weight and limiting your daily sodium intake to less than 2,300 milligrams (one teaspoon).
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