Beta-blockers

Published by Bupa's health information team, September 2009.

This section contains answers to common questions about this topic. Questions have been suggested by health professionals, website feedback and requests via email.

Why should beta-blockers be stopped gradually?
Can you tell me more about the side-effects of beta-blockers?
Why are beta-blockers no longer used much to treat high blood pressure?

Why should beta-blockers be stopped gradually?

Answer

Beta-blockers affect the way your heart works by slowing it down and causing it to beat with less force. Your body gets used to this, so it can be harmful if you stop taking beta-blockers suddenly. Always talk to your doctor for information and advice before you stop taking any regular medicines.

Explanation

Don't stop taking your beta-blockers suddenly unless your doctor has specifically told you to. This means taking care not to run out of tablets. For example, if you go on holiday, make sure you have enough for the whole time you're away.

Beta-blockers affect the way your heart works. They slow it down so that it beats less often. They also work to reduce the force of each beat (contraction) of your heart. Your body becomes used to these effects, so if you stop taking beta-blockers suddenly, it can be harmful. Your blood pressure may go up suddenly, you may get irregular heart rhythms or your heart may be damaged. If you take beta-blockers to treat chest pain (angina) or because you have had a heart attack, stopping your tablets abruptly could make your chest pain worse or even bring on a heart attack.

If you want to stop taking your beta-blockers, for example, because they cause unpleasant side-effects, talk to your doctor for advice. He or she may be able to give you a different medicine. Your doctor may give you another medicine while you slowly stop the beta-blocker. You will probably need to take smaller and smaller doses of your beta-blocker over a few weeks until you stop completely.

When you stop taking a beta-blocker you may feel your heart beating faster for a while. This is because beta-blockers slow down your heart rate and when you stop taking them your heart will beat faster. However, if your heart rate speeds up a lot, you should see your GP or nurse for advice.

Sources

•    Hypertension guideline. National Institute for Health and Clinical Excellence (NICE), 2006. www.nice.org.uk
•    Beta-blockers – blood pressure medication. British Blood Pressure Association. www.bpassoc.org.uk, accessed 21 May 2009
•    MI – secondary prevention. Clinical Knowledge Summaries. www.cks.library.nhs.uk, accessed 21 May 2009
•    Angina. Clinical Knowledge Summaries. www.cks.nhs.uk, accessed 21 May 2009

Can you tell me more about the side-effects of beta-blockers?

Answers

Like all medicines, beta-blockers can cause side-effects. Many of these are mild and will go away after a few weeks. Some of the more common side-effects of beta-blockers are tiredness, cold hands and feet, sleep problems and a slow heart rate. If you think you have side-effects from your medicines, talk to your GP or nurse for advice.

Explanation

There is no way of knowing before you take a medicine whether you will have side-effects from it, and everyone is affected differently. You may find you have side-effects when you first start taking a beta-blocker but that they wear off after a few weeks or months. However, it's possible that they will continue and sometimes they can be severe. If you think you may be having side-effects from your beta-blockers, speak to your GP or nurse for advice.

When you read the patient information leaflet that comes with your tablets you will see a list of side-effects, some of which can look serious and frightening. Many of the side-effects listed happen to just a few people and you may not have any side-effects at all. Some of the most common general side-effects for beta-blockers are listed here.

•    Slow heart rate – one of the ways in which beta-blockers work is to slow down your heart rate. If you're worried that your heart rate is too low, see your GP. He or she may cut down the dose of beta-blocker you take or ask you to try a different medicine.
•    Cold hands and feet – because beta-blockers cause your heart to pump with less force and less often, it's possible that less blood will reach the parts of your body that are furthest away from your heart. Therefore, you may develop cold hands and feet, particularly in the winter. Beta-blockers can cause or worsen a condition called Raynaud's phenomenon, which causes cold hands and toes.
•    Breathing difficulties – a small number of people have a reaction to beta-blockers called bronchospasm. This is when your airways suddenly narrow, causing you to cough or have problems breathing. Beta-blockers can also bring on asthma. You shouldn't take beta-blockers at all if you have asthma or have had bronchospasm in the past. Seek urgent medical attention if you have trouble breathing when you're taking beta-blockers.
•    Tiredness – you may feel tired and lethargic, and this can have an impact on your day-to-day life. Because beta-blockers slow down your heart rate they can affect the amount of nutrients and oxygen that reach the rest of your body. This can affect your energy levels. You may start to put on weight if you become less active.
•    Some beta-blockers can cause sleeping problems and nightmares. Your GP may be able to change the kind of beta-blocker you take which may help to improve these symptoms.

Sources

•    Angina. Management. Clinical Knowledge Summaries. www.cks.library.nhs.uk, accessed 21 May 2009
•    Joint Formulary Committee, British National Formulary. 57th ed. London: British Medical Association and Royal Pharmaceutical Society of Great Britain, 2009
•    Beta-blockers – blood pressure medicines. Blood Pressure Association. www.bpassoc.org.uk,  accessed 21 May 2009
•    Raynaud’s phenomenon. Arthritis Research Campaign. www.arc.org.uk, accessed 21 May 2009
•    Rang HP, Dale MM, Ritter JM, et al. Pharmacology. 6th ed. London: Churchill Livingstone, 2007:182

Why are beta-blockers no longer used much to treat high blood pressure?

Answer

Beta-blockers have been used for many years to treat a wide range of conditions and up until recently were often prescribed to reduce blood pressure. However, recent research has shown that some other medicines work better to reduce blood pressure and also reduce your risk of developing serious conditions such as diabetes and stroke.

Explanation

Until recently, if you had high blood pressure, you were likely to have been prescribed beta-blockers to treat it. You may have taken them on their own or with other medicines including diuretics and angiotensin-converting enzyme (ACE) inhibitors. However, UK blood pressure treatment guidelines now recommend that other medicines are used instead.

Your GP will usually only suggest beta-blockers to treat your high blood pressure in certain circumstances, for example, if you are younger than 55 and are trying to get pregnant or can’t take other types of medicine.

You may also be prescribed beta-blockers if you have other problems that they would also help with, for example, if you have had a heart attack or if you have angina.

You could also be prescribed beta-blockers in combination with other medicines if these medicines alone are not controlling your blood pressure.

The guidelines changed because research studies showed that beta-blockers aren't as effective as some other newer medicines such as ACE inhibitors and calcium-channel blockers. These medicines are also much better at reducing your risk of heart attack or stroke.

The research also showed that:
•    other available medicines generally cause fewer side-effects
•    taking beta-blockers with a diuretic medicine to lower your blood pressure, something that was relatively common, increases your risk of developing diabetes
•    beta-blockers are less effective than other blood pressure medicines at reducing heart disease and stroke

Speak to your GP for more information and advice as there may be specific reasons for you to take beta-blockers despite the findings of these research studies.

Further information

•    Blood Pressure Association
www.bpassoc.org.uk

Sources

•    Beta-blockers - blood pressure medicines. Blood Pressure Association. www.bpassoc.org.uk, accessed 21 May 2009
•    Hypertension: management of hypertension in adults in primary care. National Institute for Health and Clinical Excellence (NICE), www.nice.org.uk, June 2006
•    Joint Formulary Committee, British National Formulary. 57th ed. London: British Medical Association and Royal Pharmaceutical Society of Great Britain, 2009
•    Rang HP, Dale MM, Ritter JM, et al. Pharmacology. 6th ed. London: Churchill Livingstone, 2007:311

Related topics

ACE inhibitors and angiotensin II receptor blockers
Calcium-channel blockers
Diuretics
Heart attack
High blood pressure
Raynaud's phenomenon
Stroke

This information was published by Bupa’s health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: September 2009.

Beta-blockers factsheet  [add link to factsheet]

Related topics

Angina
Anxiety disorders
Arrhythmia
Glaucoma
Heart failure
High blood pressure
Migraine

Further information

• electronic Medicines Compendium
www.emc.medicines.org.uk

Sources

•    Joint Formulary Committee, British National Formulary. 57th ed. London: British Medical Association and Royal Pharmaceutical Society of Great Britain, 2009: 85–91
•    Hypertension: management of hypertension in adults in primary care. National Institute for Health and Clinical Excellence (NICE), www.nice.org.uk, June 2006
•    Rang HP, Dale MM, Ritter JM, et al. Pharmacology. 6th ed. London: Churchill Livingstone, 2007:180–1
•    MI – secondary prevention. Clinical Knowledge Summaries. www.cks.library.nhs.uk, accessed 21 May 2009

This information was published by Bupa’s health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: September 2009.