Beta blockers are among the most trusted and most prescribed drugs in the pharmacy. Medications such as atenolol (Tenormin), metoprolol (Lopressor, Toprol) and the granddaddy of them all, propranolol (Inderal) have been taken by tens of millions of patients for decades.
Initially, beta blockers were developed to treat chest pain and lower blood pressure. They are also used to control irregular heart rhythms. The scientist who developed propranolol, Sir James Black, was honored with the 1988 Nobel Prize for medicine because of this drug discovery.
After more than 40 years as a mainstay for the treatment of hypertension, beta blockers are losing their luster. The Cochrane Collaboration is an independent, highly regarded organization of outside experts who review the world’s evidence on drugs.
A recent analysis concludes that, “Beta-blockers are not recommended as first line treatment for hypertension as compared to placebo due to their modest effect on stroke and no significant reduction in mortality or coronary heart disease” (Cochrane Database of Systematic Reviews, Nov. 14, 2012).
What will have doctors scratching their heads in disbelief is a study in the Journal of the American Medical Association (JAMA, Oct. 3, 2012). The investigators tracked 44,708 high-risk heart patients. These people had had a heart attack or were diagnosed with coronary artery disease. After roughly 44 months of follow-up, there was no evidence beta blockers prevented second heart attacks, strokes or death due to cardiovascular causes.
Beta blockers may still be helpful immediately after a heart attack, but long-term use appears less beneficial than previously believed. And side effects can be daunting.
Beta blockers can make breathing more difficult, especially for people who are susceptible to asthma. Other complications may include fatigue, dizziness, slow heart rate, depression, sleep disturbances, hair loss, digestive upset, weakness and sexual dysfunction.
No one must ever stop a beta blocker suddenly, however. Doing so could trigger chest pain, irregular heart rhythms or even a heart attack.
Many physicians will find the new research challenging. According to the authors of the JAMA study, in 2010 nearly 34 million prescriptions were written for atenolol alone.
Patients taking such drugs as first-line treatments for high blood pressure may need to ask their doctors about other options. The authors of the Cochrane report suggest that some other types of medications such as diuretics, calcium antagonists or ACE inhibitors may be more effective for preventing premature death.
To learn more about this controversial topic and the pros and cons of various other therapies, we offer our Guide to Blood Pressure Treatment. Patients on beta blockers should ask their doctors to review the latest research from the JAMA and Cochrane to determine whether such drugs are still appropriate.