ACE Inhibitors vs. Beta Blockers: How Are They Different?

Have you ever wondered why sometimes multiple blood pressure medications are necessary? Or why someone you know might be taking one type of blood pressure medication, while you’re taking another?

There are many classes, or types, of blood pressure medications, like angiotensin-converting enzyme (ACE) inhibitors and beta blockers. Here, we’ll talk about their similarities and differences, and how they can work together to support your heart health.

What are ACE inhibitors?

ACE inhibitors are a class of blood pressure and heart medications. They relax blood vessels, which lowers blood pressure and allows more blood to flow to the heart. 

We don’t exactly know all of the effects that ACE inhibitors have on the body. But we do know how they generally work. We’ll talk more about this in the next section.

What do ACE inhibitors do?

To understand how ACE inhibitors work, let’s address the “ACE” component first, and then the “inhibitor” part. ACE refers to a protein that creates the chemical, angiotensin II. Angiotensin II causes your blood vessels to become narrow and your blood pressure to rise.

The “inhibitor” part means that medications in this class block the activity of ACE. As a result, your body doesn’t make as much angiotensin II. This helps relax your blood vessels and lower your blood pressure.

What conditions do ACE inhibitors treat?

Given how they work, ACE inhibitors treat high blood pressure. When taken alongside other medications, they can also help treat heart failure and heart attacks. Other benefits of this medication class include protecting the kidneys and lowering the risk of stroke.

Here’s a list of common FDA-approved ACE inhibitors:

• Benazepril (Lotensin)

• Captopril

• Enalapril (Vasotec)

• Fosinopril

• Lisinopril (Zestril)

• Quinapril (Accupril)

• Ramipril (Altace)

What are potential side effects of ACE inhibitors?

Common side effects of ACE inhibitors include:

• Dry cough

• Low blood pressure (hypotension)

• Dizziness

• Fainting

• High potassium levels (hyperkalemia)

Low blood pressure may happen during the early months of treatment because your body is getting used to the medication. Sometimes the side effects are mild and will go away on their own. But if they become bothersome or won’t go away, let your healthcare provider know. 

Other well-known side effects of ACE inhibitors include dry cough and swelling in the mouth and face, known as angioedema. If you have a cough that won’t go away, your healthcare provider may suggest switching to a different class of medications. 

But if you experience angioedema while taking an ACE inhibitor, get medical help right away. Your healthcare provider may recommend a different type of medication, and you may be advised to avoid ACE inhibitors to prevent this reaction from happening again.

What are beta blockers?

Beta blockers are a class of heart medications that lower heart rate and blood pressure. They can also prevent excess eye fluid, causing lower eye pressure. These medications are used for different heart conditions and some eye conditions like glaucoma.

How do beta blockers work?

Even though they treat many similar conditions, beta blockers work differently than ACE inhibitors. They target beta-1 receptors (chemical binding sites) in the heart. 

Normally, when those receptors are activated, the heart pumps faster and harder. In turn, this leads to a faster heart rate and higher blood pressure. By blocking beta-1 receptors, beta blockers help lower your heart rate and blood pressure.

What conditions do beta blockers treat?

Beta blockers treat many of the same conditions as ACE inhibitors, including high blood pressure, chronic heart failure, and stroke. Some beta blockers can also be used to prevent migraines.

Unlike ACE inhibitors, beta blockers can help relieve angina (chest pain). Some beta blockers have even more uses, like correcting an irregular heartbeat and treating glaucoma. And one beta blocker may be used off-label to help with performance anxiety.

Types of beta blockers

Beta blockers are often divided into two groups based on how broad their effects are. For example, some beta blockers only work on the beta-1 receptors in the heart. These are called cardioselective beta blockers because their effects are mostly limited to the heart.

Cardioselective beta blockers include:

• Acebutolol 

• Atenolol (Tenormin)

• Betaxolol 

• Bisoprolol 

• Metoprolol tartrate (Lopressor)

• Metoprolol succinate (Toprol XL)

• Nebivolol (Bystolic)

Non-cardioselective beta blockers can block both beta-1 receptors in the heart as well as beta-2 receptors found in the blood vessels and the lungs. This means that these medications not only affect the heart, but can have effects on other parts of the body. For example, blocking beta-2 receptors can cause the lung’s airways to tighten as a side effect, which can cause a sudden worsening of symptoms in people with asthma (asthma attacks).

This is a list of non-cardioselective beta blockers:

• Carvedilol (Coreg)

• Labetalol

• Nadolol (Corgard)

• Pindolol 

• Propranolol

• Sotalol (Betapace)

• Timolol

Risks of using beta blockers in certain populations

Choosing between an ACE inhibitor or a beta blocker depends on many factors, including the specific condition you need to treat. If you need medication to manage your blood pressure, for example, both ACE inhibitors and beta blockers could work. But, your medical history and other health circumstances will also affect which type of medication is best for you.

What are potential side effects of beta blockers?

Side effects of beta blockers could include:

• Low blood pressure, especially when changing positions

• Low heart rate

• Dizziness

• Nausea

• Constipation

• Fatigue

• Heart rhythm problems

Some people report feeling tired, drained, and not like themselves when starting a beta blocker, but sometimes these side effects can go away on their own. It can take a few weeks to get used to taking a beta blocker. 

Non-cardioselective beta blockers have a few other side effects you should be aware of because they affect the lungs. These medications can make breathing more difficult, so people with conditions like asthma and chronic obstructive pulmonary disease (COPD) should talk with their healthcare provider before taking a beta blocker.

Your healthcare provider will help you figure out whether an ACE inhibitor, beta blocker, or both are right for you based on your medical history and any other medications you take.

Combination ACE inhibitor and beta blocker treatment

Healthcare providers may recommend taking an ACE inhibitor and beta blocker together. This combination can be helpful because these types of medications tend to have complementary effects that can prevent heart problems. You might need an ACE inhibitor and a beta blocker if:

• Your blood pressure is very high and/or you also have a high heart rate 

• You have chronic heart failure

• You’ve had a heart attack in the past or are at high risk for having one

• You have a heart rhythm condition called atrial fibrillation (AFib)

Are there any side effects to taking ACE inhibitors and beta blockers together?

Using both ACE inhibitors and beta blockers together may come with a higher risk of certain side effects. For example, both types of medications can cause low blood pressure and dizziness, so there is a higher likelihood of you experiencing these symptoms.

But, some experts say that using two classes of medications (like ACE inhibitors and beta blockers) to treat blood pressure can have fewer side effects than using high doses of one class alone.

Why trust our experts?

Written by:

Austin Ulrich, PharmD, BCACP

​​Austin Ulrich, PharmD, BCACP, is a board-certified ambulatory care clinical pharmacist. Ulrich’s experience includes direct patient care in hospital and community pharmacies.

Edited by:

Samvida Patel, MNSP, INHC

Samvida Patel, MNSP, INHC, is a health editor at GoodRx. She is a nutritionist and integrative nutrition health coach with over 8 years of experience in health communications.

Reviewed by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

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