How Effective Are Beta Blockers As First Line Treatments for Hypertension?

The correlation between beta blockers and hypertension can be traced back by decades of years. The first beta blocker was introduced in the year 1960 and ever since then it has changed the game of treating heart issues. Over the next four decades, these drugs have undergone revolutionary changes and today millions of people are using beta blockers all over the world for management of hypertension.

What is Hypertension?

Hypertension is the medical term for increased blood pressure, i.e. the pressure of the blood in the blood vessels is higher than normal. It is a medical condition where the force exerted by the blood against the blood vessel is too high.(1) Hypertension is multifactorial and can occur due to various underlying conditions. It has been seen that 1 in every 3 adults in the United States of America have elevated blood pressure.(2) Hypertension, if left untreated, can lead to other complications. In most of the cases hypertension can be treated and controlled. At present, the most common medication used to control this condition is called as beta-blockers.

What are Beta Blockers?

Beta Blockers (also known as beta adrenoceptor blocking drugs) are group of specialised medicine that are prescribed for treatment and management of cardiac issues.(3)

They have the ability to lower blood pressure and control heart rate and making it easy for the heart to pump out blood more efficiently.(4) The exact mode of action of beta blockers in controlling elevated blood pressure is not yet completely understood. Extensive studies are being carried out to understand the exact pathogenesis of this drug.

The most common heart issues that are treated with beta blockers (often in conjunction with other treatment) are listed below:(3,5)

How Effective Are Beta Blockers As First Line of Treatment For Hypertension?

In the past, beta blockers were considered as the first line of treatment for elevated blood pressure. Over the years, with advancement in medical sciences and pharmaceuticals, this assumption is changing. When compared with other anti-hypertensive medications (i.e. blood pressure lowering medication) available in the market beta blockers may not be as effective in controlling blood pressure.(6) However it is often the first choice of drug because beta blockers help in reducing the heart output, alter the baroreceptor reflex sensitivity and block peripheral adrenoceptors. This is possibly why beta blockers are extensively used to treat blood pressure. The available evidence show that older generation of beta blockers are not effective as first line of treatment of elevated blood pressure, but not much is known about the newer beta blockers such as carvedilol and nebivolol (which may be better than the older generation beta blockers in controlling blood pressure).(7)

As per guidelines of NICE (National Institute for Health and Clinical Excellence) – the advisory body of NHS in England and Wales- Beta blockers are no longer considered as the first line of treatment in management of hypertension. Based on the age and health conditions of the patients, the newer choice of drugs for first line treatment are calcium channel blockers, thiazide-type diuretic, ACE inhibitors or angiotensin receptor blocker.

The most common examples of beta blockers used for controlling blood pressure are listed below:(3)

  • Atenolol
  • Celiprolol
  • Setalol
  • Dilatrend (Carvedilol)
  • Hybloc (Labetalol)
  • Betaloc/Lopressor (metoprolol)
  • Bosvate (Bisoprolol).

Beta blockers are usually prescribed in low dosage initially for a few weeks and the dosages are increased depending on the severity of the condition and each individual patient’s response.(5,8) It is often prescribed for a couple of months. It is important to remember that beta blockers should not be discontinued suddenly without prior consultation with a physician. This can have damaging effect and can make the patient feel very ill. The dosage is often tapered off before discontinuation and this should be done only as advised by a clinician.(8)

Side Effects of Beta Blockers

Beta blockers can be prescribed for multiple health issues. However the most commonly experienced side effects of beta blockers when taken for controlling blood pressure are mentioned below:(3,5)

Conclusion

Beta blocker is a drug that is extensively used for management of heart issues including increased blood pressure. In the past, this was the first choice of drug for controlling blood pressure, but at present this assumption is changing. There are other newer generation drugs available which provide better outcome. Nevertheless beta-blockers are still used worldwide for treating hypertension extensively.

References:

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