Drug Comparisons

Beta blockers relax blood vessels and help the heart beat more regularly. This helps reduce high blood pressure, also known as hypertension. Effectively treating hypertension has been shown to reduce illness and death associated with heart disease and to help prevent other diseases such as stroke and heart failure.

The name "beta blocker" refers to a medication that "sticks" to certain proteins located on various organs throughout the body. These proteins are called beta receptors. Beta blockers attach to the receptor and block other substances that can raise blood pressure from attaching to it. The substances that can raise blood pressure are called catecholamines (pronounced: Kat-eh-KOL-uh-mEEns). Everyone has them, but they don't always cause hypertension. This may help explain why beta blockers work better in certain patients than others.

The seventh report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) recommends diuretics as initial drug choices for many patients, but beta blockers may be a good choice for patients with heart failure, heart attack or at high risk for coronary heart disease, or diabetes.

Drugs in this Class
Acebutolol ( Sectral )
Atenolol ( Tenormin )
Atenolol Injection ( Tenormin Injection )
Betaxolol Oral ( Kerlone Oral )
Bisoprolol ( Zebeta )
Metoprolol Extended-Release Tablets ( Metoprolol Succinate Extended-Release Tablets, Toprol-XL Extended-Release Tablets )
Metoprolol Tablets ( Lopressor Tablets, Metoprolol Tartrate Tablets )
Nadolol Tablets ( Corgard Tablets )
Penbutolol Tablets ( Levatol Tablets, Penbutolol Sulfate Tablets )
Pindolol Tablets
Propranolol Extended-Release Capsules ( Inderal LA Extended-Release Capsules, Innopran XL Extended-Release Capsules, Propranolol Hydrochloride Extended-Release Capsules )
Propranolol Tablets ( Inderal Tablets, Propranolol Hydrochloride Tablets )
Timolol Tablets

Summarizing the Evidence

• In general, clinical trials have shown that these drugs have similar effectiveness in the control of high blood pressure. Side effects are also similar among drugs in this group. Nebivolol is a newly approved beta-blocker. It may have some advantages over the other beta blockers as it has additional blood pressure lowering effects due to nitric oxide release. Nitric oxide causes blood vessels to relax and dilate (open up) which leads to a decrease in blood pressure. More studies are needed to determine if the differences between nebivolol and the other beta blockers are important.

• There are special circumstances where beta blockers are not considered the medications of choice for the initial treatment of high blood pressure. The choice of which beta blocker to use will typically depend on your doctor's preference and/or your prescription benefits formulary.

• Notable differences among the beta blockers are listed below:
  • Acebutolol, atenolol, betaxolol, bisoprolol, and metoprolol have more activity that is selective to the heart than other beta blockers. Those with activity selective to the heart are preferred over other beta blockers in individuals with asthma or blood vessel disease. However, at higher doses, the selectivity to the heart may be lost.

• Beta blockers are generally well tolerated with mild side effects. In the past, beta blockers were thought to be not as well tolerated as other drugs used to treat high blood pressure. However new studies have shown that they are better tolerated than previously thought. Common side effects of beta blockers include fatigue, dizziness, depression, low blood pressure and low pulse. Nebivolol may be better tolerated than the other beta blockers.

• Recent research has shown that beta-blockers should not be considered first-line therapy for older patients with high blood pressure without another indication for these agents; however, in younger patients beta-blockers are associated with a significant reduction in heart related illness and death. African Americans may not respond well to beta blockers. However, nebivolol is thought to be more effective as it dilates blood vessels.

Dosing and Administration

• There are a number of beta blockers available that can be taken once daily. These include atenolol, bisoprolol, carteolol, metoprolol ER (extended release), nadolol, nebivolol, penbutolol, and propranolol ER (extended release). Acebutolol is often taken once or twice daily. Beta blockers that require multiple doses throughout the day include metoprolol oral (immediate release), pindolol, propranolol oral (immediate release), and timolol.

Generic Availability

• Not all beta-blockers are currently available in generic formulations. Nebivolol and penbutolol are not available as a generic. All other beta-blockers have generic equivalents.

Drug Interactions

Some interactions between medications can be more severe than others. The best way for you to avoid harmful interactions is to tell your doctor and/or pharmacist what medications you are currently taking, including any over-the-counter products, vitamins, and herbals. For specific information on how the drugs interact and the severity of the interaction, please use our Drug Interactions Checker.

Side Effects

To view specific side effect information, please use our Side Effect Checker.

Additional Information

References

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2. Zebeta [package insert]. Pearl River, NY: Lederle Laboratories; December 2001.
3. Toprol-XL [package insert]. Wilmington, DE: AstraZeneca; March 2007.
4. Drug Facts and Comparisons. Updated Monthly. St. Louis, MO: Facts and Comparisons. 2007, 2008.
5. Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. JAMA. 2003;289:2560-2572.
6. Constant J. A review of why and how we may use beta-blockers in congestive heart failure.
7. Carter BL, Saseen JJ. Hypertension. In: Pharmacotherapy: A Pathophysiologic Approach. 6th ed. Dipiro JT, Talbert RL, Yee CG et al., eds. New York, McGraw-Hill; 2005:185-217.
8. Khan N, McAlister FA. Re-examining the efficacy of beta-blockers for the treatment of hypertension: a meta-analysis. CMAJ. 2006;5:1737-42.
9. Dhakam Z, Yasmin, McEniery, et al. A comparison of atenolol and nebivolol in isolated systolic hypertension. J Hypertens 2008 Feb; 26(2):351-6.
10. Van Bortel LM, Fici F, Mascagni F. Efficacy and tolerability of nebivolol compared with other antihypertensive drugs: a meta-analysis. Am J Cardiovasc Drugs 2008:8(1):35-44.
11. Wojciechowski D, Papademetriou V. Beta blockers in the management of hypertension: focus on nebivolol. Expert Rev Cardiovasc Ther 2008 Apr; 6(4):471-9.

Last Updated: May 2008
This content was created by members of the DrugDigest team of experts and is solely under DrugDigest's editorial control.

Note: The above information is intended to supplement, not substitute for, the expertise and judgment of your physician, pharmacist, or other healthcare professional. It should not be construed to indicate that the use of the product is safe, appropriate, or effective for you. Consult your healthcare professional before taking any medication.