Everything You Need To Know About Beta Blockers


Unnoticed for decades in the past, heart diseases have now come into the limelight as one of most common causes of death, not only in the USA but throughout the world. As statistics would show, about a quarter of those living in the US succumb to some sort of heart disease and that 65% of those aged 65 and above are now dependent on heart medications. This data is based on studies carried out by the Centers for Disease Control and Prevention.

The most common medications that are being prescribed today for heart-related problems are beta-blockers. These are used to treat irregular heartbeats, chest pains, and high blood pressure. Doctors agree that beta-blockers are important not only in managing symptoms of heart diseases but also in preventing heart attacks, especially those who have experienced it for the first time. Beta-blockers are indeed the most in-demand medication for those with heart issues. Here is some information about this indispensable medication that was invented by a grieving son whose father succumbed to a heart attack.

A Short History

Back in the early part of the 1960’s, Sir James W. Black, a Scottish pharmacologist developed propranolol which was the very first beta blocker. He developed the drug after he studied the effects of adrenaline on a person’s heart. His interest in beta blockers began when he was still a medical student. At that time, his father got into a minor car crash, suffered a heart attack, and died suddenly. Black believed that the heart attack that caused his father’s death was caused by an adrenaline rush as he experienced the accident. Because of this, he dedicated himself to developing a medication which can relax the heart. In the year 1988, black received the Nobel Prize in Medicine  Part of this was because of the breakthrough medication he developed. Black also developed a medication known as cimetidine which is effective in the treatment of stomach ulcers.

In the years since Black invented beta blockers, doctors have used them to combat heart diseases and their symptoms. According to studies, beta blockers can reduce the risk of sudden death from cardiac events such as heart attacks by more than 30%. With such medications, heart rhythms can feel better, angina improves, and more. In fact, most people who take beta blockers feel better because of them.

Over the decades. beta blockers have become more and more targeted. In the beginning, were only “non-selective” which means that they only blocked the adrenaline receptors in a person’s heart as well as in the other organs such as the liver, lungs, and kidneys. Over time, beta blockers became more sophisticated which means that they could be used for other purposes as well. Nowadays, there are more than 10 beta blockers available and they all have different purposes.

According to experts, the best way to prescribe this type of medication is to start with a small dose. Then, the doctor may increase the prescription every two, three or four weeks until the patient reaches his target dose. This will help prevent the occurrence of bradycardia or a slow heartbeat. Also, if a person wants to stop taking the medication, he has to do so gradually so as not to shock his body.

Fast Facts About Beta Blockers

Beta blockers are a type of medication which work by temporarily reducing or stopping the natural “fight-or-flight” responses of the body. This, in turn, reduces the stress on the other body parts such as the brain, blood vessels, and the heart. Beta blockers can protect a person against heart attacks, lower blood pressure, and even improve the outlook for those who experience heart failure. Here are some fast facts about these medications:

  • Doctors prescribe beta blockers for different conditions including angina, anxiety, glaucoma, symptoms of an overactive thyroid, high blood pressure, and more.
  • Some people may call them beta-adrenergic antagonists, beta-antagonists or beta-adrenergic blocking agents.
  • James Black, the pharmacologist from Scotland was awarded the Nobel Prize in Physiology and Medicine, in part, for developing the beta blocker known as propranolol which is still being used until today.
  • Typically, doctors prescribe beta blockers to patients whose heart rate needs to be slowed.
  • There are various types of beta blockers available in the market now.
  • Beta-blockers may cause some side effects such as weight gain, fatigue, dizziness, and cold feet and hands.

How Do Beta Blockers Work?

The heart is an organ that works non-stop, 24/7, 365 days a week until the end of a person’s life. It pumps blood in and out continuously so that nutrients and oxygen are delivered to every cell in the body. One of the important hormones associated with the heart’s activity is adrenaline which is produced by the adrenal glands. Many of us have heard about an “adrenaline rush” where the hormone is produced to face “flight-or-fight” situations. This is an automatic response by the adrenal glands, especially when the person is threatened or scared. Adrenaline also helps people in competitive events. The production of adrenaline during competitions can make people feel pumped up. They can feel their hearts beat faster, getting ready to perform at their best for the events at hand.

Adrenaline, however, becomes a problem for those with heart issues. A heart problem can be detected by the cardiovascular system and this can will trigger the release of more adrenaline. More of this hormone means faster heartbeats. This is where beta-blockers can serve their purpose because they can decrease the effects of adrenaline by interfering with beta receptors located in the heart and elsewhere in the body. With less adrenaline in the blood because of beta-blockers, the heartbeat becomes slower and more predictable.  Beta-blockers are used to slow down the beat of the heart to a more normal rate.

The Functions of Beta Blockers

The main function of beta blockers is to block the adrenaline and noradrenaline hormones in a person’s sympathetic nervous system which is an important part of the autonomic nervous system. The sympathetic nervous system’s primary function is to stimulate the body’s fight-or-flight response. When the body is under stress, the adrenal hormones are pumped into the bloodstream to make the muscles of the person’s body prepared for exertion. This is a vital and natural response to danger. Too much of these adrenal hormones can potentially be dangerous as it may lead to excessive perspiration, rapid heartbeats, anxiety, heart palpitations, and high blood pressure.

When the hormone release is blocked, the demand for more oxygen decreases and stress in the heart is reduced. Then the strength of the heart muscles’ contractions is also diminished. This, in turn, will lower the strain on the blood vessels in the brain, the heart, and the other parts of the person’s body. Aside from the adrenal hormones, beta-blockers can also block angiotensin II production, This is a hormone that comes from the kidneys which will relax and widen the blood vessels. As a result, there will be an easier blood flow through the blood vessels. Beta-blockers are generally used in the treatment of the following cardiovascular illnesses:

  • Chest pains or angina
  • Heart failure.
  • High blood pressure or Hypertension
  • Irregular heartbeats or atrial fibrillation
  • Myocardial infarction

The Uses of Beta Blockers

The adrenaline hormone, indeed, could be a lifesaver. In times of duress, the body will naturally produce this hormone to prepare the body for any event of harm. We’ve already talked about the “adrenaline rush” where the hormone is produced to face “flight-or-fight” situations. Important as it may be, too much adrenaline is bad for the body, especially for those who have heart problems where it can cause a variety of problems. Luckily now, we now have beta-blockers. These medications are used to slow down the beat of the heart to a more normal rate thus lowering blood pressure, palpitations, and more. Beta blockers are truly the most popular medication used by cardiologists. Here are some uses of these medications:

Hypertension or High Blood Pressure. Excessive stress on the blood vessels and the heart caused by high blood pressure could be dangerous as it can lead to a stroke or heart failure. Taking beta-blockers may help lower the blood pressure as the medication’s main function is to slow down the heart from exerting too much work. With blockers, the heart will slow down, beat harder, and less often. This, logically, will decrease blood pressure.

Angina or Chest Pains. Chest pains are experienced when the heart feels pressure where it will be required to force blood through narrow blood arteries which have been clogged with plaque. Using beta-blockers will help decrease the volume of blood that is being pumped around. This will decrease blood pressure and, consequently, will reduce chest pains.

Irregular Heartbeats or Arrhythmia. Some of us do experience rapid heartbeats but this becomes worrisome in case they become irregular, especially when the heart is beating really fast. Bear in mind that beta-blockers won’t bring back the heart to a regular beat but the medication can slow down the heart rate.

Heart Attack or Myocardial Infarction. It’s common sense that after one experiences a heart attack, he should not subject his heart to too much stress. It will need the rest. Beta-blockers can help by reducing the stress on a person’s heart and this can prevent the occurrence of another attack.

Doctors have also discovered that beta-blockers can also be beneficial for certain diseases other than those involved with the heart. A report found that beta-blockers can also be used to overcome phobias. Take, for instance, the study conducted on arachnophobia patients which showed that after taking beta-blockers, the subjects became comfortable enough to touch spiders. Here are other conditions which may benefit from beta blockers:

Glaucoma. Glaucoma is an eye disease which results in damage to the optic nerve and may lead to vision loss. This is caused by high pressure within a person’s eyeball. Beta-blockers in eye drop form can help reduce such pressure by lowering the fluid production in the eyeball.

Anxiety. Psychiatrists are now prescribing beta-blockers to help reduce anxiety and stress. The beta-blockers action of blocking the effects of adrenaline can also lead to calmer hearts as well as minds.

As we have mentioned earlier, adrenaline in the blood can cause anxiety, especially for those with cardiovascular issues. Beta-blockers can block the effects of the adrenaline hormone. When taken, the blockers can reduce the symptoms of anxiety, most common of which are sweating and trembling. Should one experience anxiety too often, it’s recommended to consult a medical professional for some additional treatment or counseling.

Tremor and Hyperactive Thyroid. Tremor refers to the involuntary shaking of the body or limbs that may be caused by disease, weakness, excitement or fear. Using beta-blockers may reduce the symptoms of tremor. The medication can also slow down the heartbeat of patients suffering from a thyroid that’s overactive. Some people have been taking beta-blockers to combat migraines and thyroid conditions.

Types of Beta Blockers and the Different Brands

There are different types of beta blockers, depending upon the type of beta receptors they block. These include:

  • Non-selective

This blocks the beta1 and beta2 receptors. They affect the heart, blood vessels and the air passages of the lungs.

  • Selective

These primarily block beta1 receptors. They mostly affect the heart but not the air passages of the lungs.

Some beta-blockers have intrinsic sympathomimetic activities (ISA), meaning they can mimic the effects of epinephrine and epinephrine. Epinephrine is a hormone associated with adrenaline and has the same effects of increasing blood pressure, heartbeat rate, and the like. Beta blockers with ISA have small effects on heart rate than other agents without it. Mainly, beta-blockers can either be non-selective or selective.  The selective type mostly affects the heart and the non-selective can affect any part of a person’s body. Here are the most widely-used brands and types of beta-blockers:

  • Acebutolol (Sectral)
  • Atenolol (Tenormin)
  • Metoprolol (Toprol XL, Lopressor)
  • Nadolol (Corgard)
  • Propranolol (Inderal LA, Hemangeol, Inderal XL, InnoPran XL)
    • Timolol Ophthalmic Solution (Betimol, Timoptic, Istalol)

The Benefits of Taking Beta Blockers

Beta-blockers are primarily known to help the heart slow down in times of distress or lower the effects of adrenaline hormones, especially on those with heart problems. Aside from these, the drug also has some other health benefits. For instance, beta-blockers can protect the bones of the body by preventing the kidneys from eliminating calcium into the urine. The drug can also block stress hormones like adrenaline, which over time, can cause the thinning of the bones because of a deficiency of calcium. Also, beta-blockers are not the first line of defense against bone-thinning, stronger bones will be an extra benefit when taking the medication. Here are the other benefits of such medications:

Effectiveness. There is substantiated evidence which shows that taking beta-blockers after a heart attack can considerably lower the risk of a repeat attack that can lead to an early death. Also, the chances of living a better and longer life are much greater. Studies have also shown that various beta-blockers function better for various conditions.

Safety. There isn’t really that much danger with beta-blockers. They are safe to take. There are some side effects but are considered more of nuisances and aren’t life-threatening. At one time, doctors didn’t want the drug to be taken by those who had chronic obstructive pulmonary diseases. The doctors worried that it could worsen their symptoms. However, more recent studies have indicated that the cautious use of these medications can reduce the risk of the flare-ups of this breathing problem and can even improve the chances of survival.

Cost. This is good news for the millions of people who depend on beta-blockers. The drug is inexpensive and is available in low-priced generic pharmacies. The choice now depends on which beta-blocker a person needs. The choice will also consider the other medical and cardiovascular conditions as well as the side effects.

Precautions One Must Look out for Before Taking Beta Blockers

Before using beta-blockers, one will need to inform his doctor about your medical history and if you have had any of these conditions:

  • Bronchospasm
  • Asthma
  • Slow heart rate
  • Severe peripheral arterial disease including Raynaud’s syndrome
  • Uncontrolled heart failure

The medication can be used by people who have stable heart failures. Patients with blood level problems like diabetes and hypoglycemia should have to keep track of their levels of blood sugar regularly. This is especially important for hypoglycemics or those with low blood sugar levels because beta-blockers may hide the indications of low-blood sugar, such as a rapid heartbeat. Pregnant women can also use beta-blockers but only under their doctor’s recommendation.

How Does One Take Beta Blockers?

The original function of beta-blockers was to treat people with hypertension or high blood pressure. Today, they’re also used to treat heart problems such as angina, irregular heartbeats, and as a prevention for heart attacks. Beta-blockers are also available in eye-drop form to be used to treat glaucoma or increased eye pressure. The drug is also effective in treating headaches but only if used properly. It’s not recommended though for stopping headaches that are in progress. To get the most effects when using beta-blockers, simply follow these tips:

  • Beta-blockers should be taken on a regular basis for them to work right. This means, taking the drug even when you are feeling well. Sounds like a maintenance drug.
  • Remember to fill out the prescriptions and refills always on time so as not run out and miss doses.
  • When intending to travel or go away for the weekend or vacations, make sure to have enough supply of beta-blockers to last the absence.
  • One may feel his condition worsen if he abruptly stops taking the beta-blockers. Check with the doctor first if one plans to stop taking beta-blockers. The doctor may want to reduce the dosages gradually before one finally stops.
  • Never stop taking the regular dosages of beta-blockers unless advised by the doctor. Suddenly stopping the treatment can worsen the condition, especially during the angina treatment or right after the person experiences a heart attack.

The Risks That Come with Taking Beta Blockers

The only risk involved when taking beta-blockers is that one will be taking them for the rest of his life unless of course, one cannot tolerate them, but that is a rare case. For those with cardiovascular issues, beta-blockers are a blessing, the drug can make them feel better. For some, there may be side effects which are tolerable which can include dizziness, tiredness, and generally feeling down. Again, only a handful will experience these side effects. In case they do, the doctors need to do more because a heart problem generally can cause tiredness.

  • Sometimes it’s difficult to discern if the fatigue feeling is caused by a heart problem or is a side effect of beta-blockers. The doctor can make adjustments on the dosage to determine if the side effects will cease in time.
  • There is also some risk for those with respiratory problems, like chronic obstructive pulmonary disease or asthma. For instance, people taking beta-blockers who have lung issues should be careful because the drug can cause the lungs to constrict and can prevent breathing. An advisory report in 2010 advised patients with respiratory ailments that they can take beta-blockers as long as they are the kind that targets only the heart’s adrenaline receptors.
  • Doctors are also careful in prescribing beta-blockers to patients who have severe diabetes because the drug can mask signs of low blood sugars. Furthermore, those with slow heart rates and low blood pressure should NOT be prescribed beta-blockers for obvious reasons.

Potential Side Effects of Beta Blockers

Beta-blockers have many benefits for people who have cardiovascular problems. They may not suffer as much anymore. Lowering the heart rate and blood pressure alone is already reason enough to love beta-blockers. But like almost everything else, we will need to deal with drug’s side effects. There are several, most of which may not even be that life-threatening but they are there and we will have to be dealt with. Here are some of the most common side effects when we use beta-blockers:

Hypotension or Low Blood Pressure. At this point, we’re all aware that beta-blockers are effective in lowering blood pressure. Precisely so because that is the reason doctors prescribe them. But the drug can work just too well that it will start to cause problems, especially when the blood pressure becomes dangerously low. This will make one feel weak and light-headed. Consult with the doctor. He may need to lower the beta-blocker dosage.

Bradycardia or Slow Heart Rate. We also know the beta-blockers can lower the heart’s rate because this is one of its primary functions. Bradycardia is one of the side effects of the medication and can make one feel strange. It does indicate though that the medication is taking effect. Again, the rate might get too low and the doctor may need to adjust or lower the dosage.

Breathing Difficulty. This side effect involves the beta2 receptors in the lungs. Beta-2 blockers can affect the beat2 receptors in the lungs and cause the airways to narrow. This can become a problem for those who have pulmonary issues involving the air passages of the lungs such as COPD and asthma. If one feels he has a difficulty in breathing, choose a selective B1 blocker. It could be a safer choice.

Beta-blockers function by modifying specific nerve impulses in the different areas of the body. This property makes it possible for beta-blockers to be used in treating different types of health issues. It’s still unclear though how they can work in preventing headaches. Maybe they block the nerve impulses that which trigger the migraine headaches. If one is experiencing any of these symptoms when taking beta-blockers, consult with the doctor:

  • Shortness of breath
  • Irregular or slow heartbeat
  • Swelling of the ankles, lower legs or feet
  • Wheezing

If one develops any of these symptoms, the person should immediately visit his doctor:

  • Light-headedness or dizziness when one gets up from a lying or sitting position
  • Depression
  • Pains in the chest or back
  • Skin Rashes
  • Changes in vision

Some side effects may show themselves while a person is on beta-blockers. On the other hand, some might cease in time after continued medication. However, is certain side effects persist, call the doctor. These persistent side effects to look out for can include:

  • Strange dreams
  • Diarrhea or constipation
  • A decreased in sexual ability
  • Feeling anxious or nervousness
  • Inadequate circulation in the feet and hands
  • Sleeping problems
  • Unusual weakness or tiredness

There’s always a chance of overdosing on any medication, even beta-blockers. In case it happens, call the doctor or the closest poison center. As a matter of fact, some types of beta-blockers in the past have been known to cause weight gain in people of more than 2 pounds in just a day. Another symptom of overdosing is fluid retention accompanied by weight gain. These are signs of heart failure or that the heart failure is worsening. The doctor should be immediately be informed if the person should gain more than 2 or 3 pounds each day or 5 pounds in a week.

One also needs to monitor changes in terms of how his heart works every day. For instance, beta-blockers can prevent any spikes in the heart rate. With beta-blockers and exercise, one will notice that his heart rate will not go as high as it normally does during his daily physical activities.

If one has any concerns about his exercise routines and how it may affect taking beta-blockers, talk to the doctor. Stress tests may be recommended to find out one’s target heart rate during one’s cardio workout. These tests may even help the doctor determine how one feels during his work-out session. This is often referred to as the rate of perceived exertion.

Possible Drugs and Supplements Which Interact with Beta Blockers

There are combinations of medications that can interact with the effects of beta-blockers. It’s important to know all these so that there’s no danger of having adverse effects because of the beta blockers. Let’s look at the most common interactions which may occur:

  • For instance, combining propranolol or pindolol with thioridazine or chlorpromazine might result in hypotension or low blood pressure. This combo can also cause abnormalities in one’s heart rhythms since the drugs can disrupt each other’s elimination, resulting in heightened levels.
  • A combination of clonidine and a beta-blocker can increase blood pressure to dangerous levels. This applies as well if the combination is stopped after the current use. Blood pressure must always be monitored closely after the initiation of the use of this clonidine and beta-blocker combo or their discontinuation after they’ve been utilized together.
  • Using phenobarbitals and similar drugs can also weaken the effectiveness of beta-blockers propanolol or metoprolol.
  • Aspirin and non-steroidal anti-inflammatory medications can also offset the blood pressure effects of the beta-blockers. The combination can reduce the effects of prostaglandins which play a pivotal role in the management of blood pressure.
  • Beta-blockers can prolong hypoglycemia or low blood sugar. The blockers can mask the hypoglycemia symptoms in diabetics who take insulin or other types of diabetic medications.

Beta Blockers Can Also Benefit People After They’ve Has a Heart Attack

The results taken from a simulation from a computer at the Institute of Health Policies Studies at the University of California have indicated that taking more beta-blockers after a person’s first experiences a myocardial infarction can result in impressive gains and that such outcome has the potential to be cost-saving.

The study showed that the increase of beta-blockers after the first heart attack was promising. The same study estimated that the initial utilization of beta-blockers for patients between the ages of 35 – 84 who survived their first myocardial infarction resulted in fewer deaths. Clinicians know the importance of beta-blockers in saving lives and that they can spare more victims of heart attacks. The practice though isn’t widely adopted yet. The study does show the lost opportunities that result from the under-use of beta blockers that are cost-saving and effective.

Not All Heart Attack Patients May Benefit from Taking Beta Blockers

At the University of Leeds, a research team conducted a study on patients who had suffered a heart attack which didn’t lead to a heart failure. This is a possible complication of heart attacks wherein the heart muscle gets damaged and it stops functioning properly. Results of the study found out that the patients who didn’t suffer from a heart failure didn’t live longer even after they received beta blockers. But more than 90% of the people in this category ended up taking the medication.

Beta blockers are a powerful type of medication which can help decrease the heart activity and lower the blood pressure. Doctors usually prescribe them after a person suffers from a heart attack. However, some people experience adverse side effects because of them. It’s a fact that not everybody who experiences their first heart attack may also have heart failure. But those who have had a heart attack and ended up with heart failure have to take beta blockers since drugs can help a damaged heart function more effectively.

The study was done in the University of Leeds though focused on people who have had a heart attack, didn’t have heart failure, but were still given beta blockers. The aim of the study was to see if taking the beta blockers had any effect on the chances of the patients still staying alive a year after their first attack.

The study raised the possibility that beta blockers are being “over-prescribed.” This, in turn, may burden the patients with medical costs which aren’t really necessary. The medical guidelines recommend that these medications must be given or prescribed to anyone who has suffered from a heart attack whether they have heart failure or not.

According to the research team, if you look at those who have had a heart attack but no heart failure, there was no significant difference in the survival rates between those who were taking bate blockers and those who weren’t taking them. Of course, this was just an observational study which was based on the statistical analysis of large-scale patient data.

Now, investigators are looking at the possibility of a randomized patient trial. Such a study would investigate a single outcome and that is if beta blockers would increase a person’s chance of survival. Also, this kind of trial would permit the researchers to substantiate the findings from the past and also search for other possible outcomes such as whether such medications can prevent any heart attacks in the future. This type of work would have significant implications for customizing the medications prescribed to patients after they’ve had a heart attack.

Of course, there is evidence pointing to the benefits of beta blockers for those who have suffered from a heart attack but didn’t end up having heart failure. But the study indicated that there might be no advantage in terms of mortality linked to the prescription of such medications for those with heart attacks but no heart failure. Therefore, the next step would be investigating the effects of beta blockers in a particular population within a randomized controlled trial.

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