Are Beta Blockers Good for Lowering High Blood Pressure?

Beta blockers are commonly prescribed for conditions like heart failure, migraines, glaucoma, tremors, and overactive thyroid. But how effective are they at lowering high blood pressure?

High blood pressure (hypertension) is when the force of the blood pushing against the artery walls is too high. Over time, high blood pressure can lead to serious health conditions, such as kidney disease, heart attack, and stroke.

Although beta blockers can work to lower high blood pressure, they’re not typically a first-choice treatment. That’s because beta blockers may not work as well as other medications to lower blood pressure — and may be less effective in certain groups of people. Here, we’ll take a look at the pros and cons of beta blockers for high blood pressure.

What are beta blockers, and how do they work?

Beta blockers are a class of drugs that are used to treat many conditions, including:

• High blood pressure

• Heart failure

• Coronary artery disease (heart-artery blockages)

• Heart attack

• Irregular heart rhythms

• Migraines

• Glaucoma

• Tremors

• Symptoms of overactive thyroid

The name “beta blocker” comes from the fact that these medications block the effects of the hormone epinephrine (also called “adrenaline”) on beta receptors throughout the body, including the heart. This slows the heart and causes it to beat with less force, which lowers blood pressure. Certain beta blockers can also cause arteries to widen, which can lower blood pressure even more.

Exactly how beta blockers work to lower blood pressure depends on the type of beta blocker. Some are more targeted at receptors in the heart and are less likely to have effects elsewhere. These are “cardioselective” beta blockers. On the other hand, “nonselective” beta blockers don’t differentiate between beta receptors in the heart and those in the rest of the body. And some target beta receptors as well as other receptors, which can further lower blood pressure.  

Why aren’t beta blockers a first choice for treating high blood pressure?

Beta blockers usually aren’t the first-choice treatment for lowering high blood pressure. While beta blockers lower blood pressure in the brachial (arm) arteries, they aren’t as good for lowering blood pressure in the main artery of the body — the aorta. As it turns out, lowering blood pressure in the aorta is more important for preventing organ damage due to high blood pressure. 

Medications that are better at lowering high blood pressure and preventing organ damage include:

• Angiotensin converting enzyme inhibitors (ACE-I)

• Angiotensin II receptor blockers (ARB)

• Calcium channel blockers (especially dihydropyridines)

• Thiazide diuretics 

ACE-I, ARB, calcium channel blockers, and thiazide diuretics are also better choices than beta blockers for Black people and people over 60 years old, where blood pressure can be harder to manage.

Finally, compared to other medications for high blood pressure, beta blockers can have a longer list of side effects, especially when taken at higher doses. Side effects are more likely to occur in people who have other medical conditions that put them at higher risk for side effects. 

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Side effects of beta blockers

Since some beta blockers work all over the body to block the effects of adrenaline, they can have unwanted effects. But whether you get side effects will depend on your unique situation and the type of beta blocker you take. Let’s go over some of the main ones.

Changes in blood sugar 

Beta blockers can hide certain symptoms of hypoglycemia (dangerously low blood sugar). Fast heart rate, tremor (shaking of the hands or feet), or nervousness can all be signals of hypoglycemia. Beta blockers tend to hide these signs because they slow the heart rate and decrease the body’s physical reaction to stress (the fight-or-flight response). However, sweating is one hypoglycemia symptom that beta blockers don’t affect.

This can become particularly problematic if you have diabetes. So, while it’s perfectly fine to take a beta blocker if you have diabetes, it's also important to follow your provider’s advice on how to keep your blood sugar at safe levels.

Dangerous slowing of the heart

Beta blockers slow the signals that control your heartbeat. This can be very useful when you have a fast heartbeat. But if you don’t, taking a beta blocker can slow your heart rate dangerously and the heart can even skip beats. 

Some people are more at risk of this than others. This includes people who have had heart rate or rhythm problems before or are taking other medication that can slow down the heart. So healthcare providers are careful about prescribing beta blockers to people who are already at risk for a slow heart rate.

Worsening asthma symptoms

In people with asthma, beta blockers can sometimes narrow the airways or make inhaler medications less effective. If a beta blocker is a must for your high blood pressure, there are specific types that work mostly on the heart (cardioselective beta blockers) and are less likely to stress the lungs. Cardioselective beta blockers include bisoprolol, metoprolol, and atenolol. 

So, who are beta blockers good for?

We’ve talked about how beta blockers are not considered a first-choice treatment for lowering blood pressure — especially when high blood pressure is severe. That said, there are special circumstances where beta blockers may be the medication of choice, either alone or along with other medications for high blood pressure. These include:

• Heart failure: This is when the heart muscle doesn't pump blood as well as it should.

• Coronary artery disease: This is when cholesterol clogs up the blood vessels that supply the heart, causing chest pain and heart attacks.

• Atrial fibrillation: This is a fast and irregular heartbeat.

Let’s dive into those special cases. 

Heart failure

In people with heart failure, lowering heart rate and widening blood vessels with a beta blocker puts less stress on the heart and reduces symptoms. Adding a beta blocker in heart failure increases the chance of living a longer life. 

Common beta blockers for heart failure include: 

• Carvedilol

• Metoprolol succinate

• Bisoprolol

Coronary artery disease (CAD)

Taking a beta blocker if you have CAD (heart-artery blockages) can help to prevent chest pain and heart attacks. Beta blockers relax the blood vessels, lowering blood pressure and slowing the heart rate. This lets more oxygen and blood fill the heart muscle, improving chest pain and the risk of a heart attack. 

If you’ve had a recent heart attack, your provider will most likely prescribe a beta blocker. That’s because it has been shown to lower your risk for another heart attack by about 25%. Now that most heart attacks are treated with stents, newer evidence doesn’t show such a dramatic effect for beta blockers. Nevertheless, they’re still routinely used to lower the risk of future heart attacks.     

Here are some common beta blockers for CAD: 

• Carvedilol

• Metoprolol tartrate

• Metoprolol succinate

• Bisoprolol

Atrial fibrillation

Atrial fibrillation is an abnormal, irregular heart rhythm that can lead to serious complications like stroke. Beta blockers are used in atrial fibrillation to slow the heart rate and improve symptoms. Beta blockers can also prevent atrial fibrillation from starting in people with high blood pressure or heart failure.

Here are some common beta blockers for atrial fibrillation: 

• Bisoprolol

• Metoprolol tartrate

• Metoprolol succinate

• Sotalol

Choosing the best beta blocker

The choice of beta blocker depends on the condition(s) being treated as well as what other medical conditions you have. Talk with your healthcare provider about which beta blocker is right for you. And never stop a beta blocker suddenly without speaking to your healthcare provider first. 

Alternatives to beta blockers for treating high blood pressure

What happens if you have high blood pressure and can’t take beta blockers, like if you already have a slow heart rate? Selecting the right treatment for your high blood pressure will depend on your medical history, age, ethnicity, and unique health situation. 

Here are a few alternatives to beta blockers for the treatment of high blood pressure:

• Lifestyle changes are a standard recommended part of all high blood pressure treatment regimens. This includes restricting the amount of salt in your diet, losing some extra weight, quitting smoking, reducing alcohol intake, and exercising regularly. They can be used alone or along with medications to get blood pressure back to healthy levels.

• Thiazide diuretics act directly on the kidneys to promote urine flow, which can reduce the amount of fluids in the body along with blood pressure.

• Angiotensin-converting enzyme inhibitors block the production of angiotensin II, a hormone the body uses to control blood pressure. They’re commonly used to protect the kidneys in people with kidney disease and diabetes.

• Angiotensin receptor blockers also block angiotensin II. They’re similar to ACE inhibitors and are used in people with similar medical conditions. But sometimes they’re more effective at lowering blood pressure.

• Calcium channel blockers prevent calcium from entering muscle cells in blood vessels, causing them to relax. Similar to beta blockers, some calcium channel blockers can also slow the heart rate.

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Written by:

Alice Perlowski, MD, MA, FACC

Dr. Alice Perlowski is a board-certified cardiologist and fellow of the American College of Cardiology. She has seen patients and supervised trainees in the academic and private sector, with focuses in interventional cardiology, vascular medicine, preventative cardiology, and women’s heart health.

Edited by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. An experienced and dedicated pulmonologist and hospitalist, she spent a decade practicing and teaching clinical medicine at academic hospitals throughout London before transitioning to a career in health education and health technology.

Reviewed by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

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