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Back Pedaling on Beta Blockers (Atenolol, Metoprolol, Propranolol) for Hypertension

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For decades American physicians prescribed beta blockers as a primary treatment for high blood pressure. When we checked a few years ago we discovered that 115 million prescriptions were dispensed for such medications annually. Assuming 30 tablets per prescription (a month's supply), that totaled 3,450,000,000 pills. Now we are being told this might have been a big oops.

New guidelines published in the Journal of the American Medical Association (JAMA, Dec. 18, 2013) for the treatment of hypertension have relegated beta blockers to the back of the line. That's because the evidence for their effectiveness in treating high blood pressure has been disappointing and there is even some suggestion of harm.

Beta blockers such as atenolol, bisoprolol, labetalol, metoprolol, nadolol,  and propranolol are prescribed for other conditions beside hypertension. Doctors have been using such drugs for decades to treat irregular heart rhythms, angina and even migraine headaches. But the overwhelming majority of the prescriptions that have been written for beta blockers over the last 40 years were to lower blood pressure.

For over a decade, however, cardiologists in the know have been encouraging their colleagues to back off beta blockers as first-line treatment for hypertension. One of the country's most renowned hypertension experts, Franz Messerli, MD, and his colleagues wrote an article titled "Beta-Blockers in Hypertension--The Emperor Has No Clothes." Here was their conclusion:

"We systematically analyzed all available outcome studies and found no evidence that beta-blocker based therapy, despite lowering blood pressure, reduced the risk of heart attacks or strokes. Despite the inefficacy of beta-blockers, the incidence of adverse effects is substantial. In the MRC [Medical Research Council] study, for every heart attack or stroke prevented, three patients withdrew from atenolol because of impotence, and another seven withdrew because of fatigue. Thus the risk/benefit ratio of beta-blockers is characterized by lack of efficacy and multiple adverse effects." F. H. Messerli et al., American Journal of Hypertension, Oct., 2003

Dr. Messerli was ignored for a very long time. A study was published in the Journal of the American Medical Association (JAMA, Oct. 3, 2012) showing no meaningful benefit from beta blockers in high-risk heart patients (who had experienced heart attacks or were diagnosed with coronary artery disease). Over 44,000 such people were followed for almost four years. At the end of the study there was no evidence that beta blockers prevented second heart attacks, strokes or death due to cardiovascular causes.

There is even some data to suggest that one of the most popular beta blockers, atenolol, might actually increase the risk of stroke compared to other kinds of blood pressure medications.

It has taken the American medical establishment a very long time to realize that beta blockers should not be prescribed as first-line treatment for high blood pressure. Thank goodness we have finally caught up with European cardiologists. They issued guidlines to this effect years ago.  We have described the whole sad saga in our book, Best Choices from The People's Pharmacy. If you would like to get a better understanding of the problems with beta blockers and what better alternatives might be available you can check out our publications.

No one must ever stop a beta blocker suddenly. Doing so could trigger chest pain, irregular heart rhythms or even a heart attack. We hope that the new guidelines will not create withdrawal symptoms or complications for millions of patients who have been taking beta blockers for years or even decades. Because there are no clear guidelines on how to phase off such drugs, doctors will need to be very cautious about this process.  No patient should ever discontinue a beta blocker without careful consultation with the prescriber.

Here are some side effects to be aware of regarding beta blockers and some stories from visitors to this website:

Beta Blocker Side Effects:

  • Fatigue, tiredness, depression
, drowsiness
  • Dizziness, lightheadedness
, vertigo
  • Itchy skin rash

  • Difficulty breathing, asthma
, wheezing
  • Slow heart rate
, palpitations
  • Cold hands or feet
, Raynaud's syndrome, peripheral edema (sweeling)
  • Sensitivity to sunlight, sunburn

  • Heart block (a problem with the rhythm)

  • Blood disorders
  • Memory problems, confusion
  • Nightmares, insomnia, anxiety
  • Digestive upset, diarrhea, nausea, constipation, flatulence
  • Arthritis, joint pain

 Stories from Visitors to this website:

"One side effect of beta blockers was not mentioned. A few years ago, when I was taking a beta blocker, I developed a red, very itchy rash on my scalp. The first question the dermatologist asked was 'Are you taking a beta blocker?' It turned out to be psorasis, and she had seen it before.

"The itching is terrible, and there is really nothing to do for it. I have tried all manner of things. Turmeric helped for a little while." E.R.


"You must wean off of it VERY GRADUALLY to lessen the effects. We did it 1/4 dose at a time for 2 weeks each step. There were still reactions at each stage; slightly elevated pulse, anxiety for no reason...but staying calm and deep breathing helps. It took about 2 months to get off completely and there were still mild spells for about another month. 

"Unknown to most people is that beta blockers dampen your bodies response to adrenalin so your poor system has to re-learn how to handle it when you stop taking them. That's what triggers the anxiety and rapid pulse." S. in Washington

"I have been on metoprolol for years and before that it was Toprol. I have searched from doctor to doctor for reasons for all my problems: coughing, palpitations, fatigue, depression, dizziness, difficult breathing, cold feet and hands, light headedness, poor coordination, and many other problems. I have asked a number of doctors to change my high blood pressure medicine but they all seem to just laugh it off. Am I wrong in wanting to change?" E.A.G.

"My husband was prescribed atenolol after a heart attack. I now sleep in a different bedroom because of his dreams. I've been punched and kicked because of his vivid dreams/nightmares to the point of bruises being left!

"It isn't every night but at least 1-2 nights per week. We didn't know what was causing them until we started investigating the side effects of his medications since it had really started just after he started atenolol." M.B.

"Since being on beta blockers for two years my hair has gotten very thin. At first I attributed this to aging, but the hair loss is substantial. It never dawned on me it could be a side effect from metoprolol." Martha

"I am a nurse practitioner and have often treated people with hypertension. Beta blockers (end in -lol) are NOT first line medications for hypertension unless you are taking them after a heart attack or because of another health condition (such as migraines). These guidelines for hypertension are brand new and will be soon published in the JNC-8.

"First line treatment is always lifestyle changes such as weight loss, exercise, smoking cessation, limited alcohol intake and decrease in added salt. Second line are medications for hypertension in the ACE (-pril), ARB (-sartan) and diuretic classes. If a provider gives you a beta blocker right out of the gate, you should be asking some questions." Julie R.


Share your own beta blocker story below. And should you wish to learn more about drugs (and non-drug approaches) for high blood pressure, check out our book, Best Choices from The People's Pharmacy. You may be surprised to learn that we predicted the end of beta blockers as first-line blood pressure medication more than seven years ago. 

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I am interested in getting off of Atenolol. I'm a 69 year old healthy male and I have been on them for a number of years. I have experienced several of the side affects I have seen listed and now it is time to discuss this with my family doctor.

Thanks for the range of pertinent information on this subject.

It's too bad that an article like this one doesn't do a better job to explain what the better alternatives are when the lifestyle changes (exercise and diet) are not enough and the ACE and diuretic come up short in lowering BP.

There are other health risks to high BP other than heart attacks. For example, someone with the LHON gene mutation might not get a heart attack with increased BP, but could be putting one's eyesight at risk. And what about the long term effect on kidneys?

Has there ever been a study to see if there is a psychological increase in side effects based on suggestion derived from published lists of side effects? This is not to doubt that side effects are real, substantial, and sometimes dangerous. Do the lists raise a psychosomatic rate of side effect cases or raise blood pressure?

It could be helpful to learn how the lists are made up. What were the methods? Scientific or anecdotal? What were the controls? And what is the chemistry in the drugs that causes specific side effects?

Thank you.

I'm taking Lisinopril for hypertension, Metoprolol for atril fibrillation. I have some of the side effects mentioned, but nothing serious enough to complain about. I take Lasix for swelling in my legs and it is supposed to help me with my congestive heart failure. It's side effect is frequent trips to the bathroom - lasts about 3 or 4 hours - very inconvenient if I want to go somewhere. Any comments or recommendations?

I've had been on atenolol for approx. 17 years when my doctor decided to switch my meds. She took me off atenolol cold pulse shot up to 120+ resting! I was breathless when even walking.

I went back to the office after 3 days of this....nurse took my was 70/ said was just my body adjusting to the new meds.

I went the next day to a new doctor......she was horrified I was taken off cold turkey and said I could have had a heart attack....she put me back on my old meds....atenolol and lisinopril....3 years later I am still on them with a BP of 120/70 at my recent appointment. I never went back to my previous doctor....never be afraid to get a second opinion!

I have been on Atenolol for 3 years for a slight mitro valve problem, and have experienced very significant hair loss and fatigue. I have read if I got off of it my hair would grow back, so I brought this up to my doctor at The Cleveland Clinic and he said he never heard of the hair loss side effect. As a woman this condition is very difficult to live with so he changed my script to Nadolol. I haven't started taking it yet, but now I am wondering Is Nadolol the same as Atenolol, and is there anything I can do to reverse the hair loss situation?

A mitral valve problem may well require a beta blocker. This is a very different situation than hypertension.
We encourage you to follow the recommendation of your cardiologist.

I have been on atenolol for 18 years. I was in my 30's when I was diagnosed with high blood pressure, 140's/90's, not terrible but high for my age at the time. My doctor prescribed 50mg of atenolol a day. It worked great. I felt better almost immediately. I went for a very long time before I realized I had not had any kind of headache. I had suffered with migraines in the past. Also, at the time I was overweight, possible cause of the high blood pressure. I finally decided I was sick of being fat, so I dieted and began walking and lost about 60 lbs. My blood pressure issue did not improve.

I was also extremely stressed at the time due to business issues (owned our own business and were struggling) and family issues, my mother was diagnosed with aggressive lung cancer in another state, so like a dummy I picked up my cigarettes again, had quit 8 years prior. My blood pressure did not change. Flash forward a couple of years, got out of business, mother passed away and moved back to home state and quit smoking, again. Stress level dropped tremendously and weight stayed off but my blood pressure was still a little high. Have since learned that I come by that honestly through heredity along with the migraines I had suffered. I did notice along the way that my hair had thinned out. Fortunately, I had a lot to start with, except my eyebrows and eyelashes are very light and thin and have to be penciled in and mascaraed. About 10 years ago my doctor added triamtrazene, forgive the spelling, along with the atenolol.

I have not had any of the major side affects and have been very happy with the results I have gotten with it. I do not have any family history of heart problems, just high blood pressure. I think the best part for me is that I have not had a migraine in all of these years. I would rather live with high blood pressure than have migraines.

It seems all I hear is no atenolol. What is a person who has a faulty fight or flight response to do?

I am really tired of hearing the phrase "when diet and exercise are not enough" because most of the time that really means that the diet and exercise you are trying are not working.

Each human being is different. What works for one person, doesn't necessarily work for the next. If you really want to be off prescription drugs, keep trying and be very honest with yourself. I have always been overweight and the honest truth is my idea of how much I should eat is more than I need. Simple. And the foods that work for me and keep me healthy are not on any specific diet plan I've ever seen.

I WAS on atenolol. Doc switched me to Micardis because of COPD. But I was doing on OK on the atenolol. Now I am tired all of the time. I thought it was the statin so I stopped taking the statin. Still experiencing fatigue.
So next doc appt I am asking to be put back on atenol. I was taking 50mg - one in the morning and one at night.

I have been taking Coreg and Exforge HCT for several years and began taking Pradaxa last year. I also take Flecainide for Afib and Lipitor plus over the counter supplements.

My dermatologist diagnosed me with a mild case of Seborrhea Dermatitis about 3 years ago. I used Nizoral shampoo which controlled the itching only somewhat but did not use it regularly because it weakened the curl of my permed hair. Then about 9 months, the itching got substantially worse, particularly my ears and my scalp. My dermatologist reminded me that there is no cure for this disease, only control, and prescribed Ciclopirox Shampoo 1% and T/Sal shampoo, to be used alternately. I use this regimen every 2-3 days, but still suffer with this miserable condition.

He also prescribed Fluocinolone Acetonide 0.01% Topical Scalp Oil which has not improved my condition. I also use Head & Shoulders Conditioner as well since all this scalp treatment has really dried out my hair. When the itching is relentless on my ears, I use Betamethasone Dipropionate Lotion USP, 0.05% which does help. Does anyone have suggestions for better controlling this condition?

People's Pharmacy response: Seborrheic dermatitis can sometimes be treated with home remedies:
such as Listerine:
Milk of Magnesia or Vicks VapoRub:

Good luck!

I have been on Atenolol, 25 mg since 1998 and about a year ago noticed my hairline had started to recede suddenly and drastically. I had ventricular tachycardia attacks in 1998 after cancer surgery, radiation and the death of my sister, all within a short period of time. I was told the stress activated the VT; during the second ablation (the first one didn't work), my heart was accidentally pierced and I almost died on the operating table. To help my heart heal, the doctor put me on Atenolol. He said I could stop it after about 3 wks. When I did stop it, the panic attacks started and the fear of going into VT scared me so much, I told the doctor I wanted to stay on the meds. He said since the dosage was so small, it wouldn't hurt me to stay on the Atenolol. I had never heard of any bad side effects. Now, fast forward to the present time.

After doing my own research and reading the many responses to People's Pharmacy, I contacted my doctor about coming off the pill. He dismissed my concerns and said it wasn't the Atenolol causing the hair loss. Three months later, I called his office again but he was out of town and I reached his physician's assistant. She called me back to report that she had indeed done her own research and one of the listed side effects of Atenolol was ALOPECIA! She convinced the doctor and he said I could cut back the dosage to 1/2 pill every day for 2 weeks and then 1/2 every other day for two weeks. Well, I tried it and as long as I didn't know what my BP and pulse readings were, I was doing great. However, when my pulse went up to 90, I panicked and started taking the pill again.

My question: what is a normal heart rate for a healthy, active 75 year old woman? And, does the heart adjust after the meds are out of your system? Why are so many people suddenly having problems and in what regions of the US? I live in Florida. Could something in the water supply be incompatible with the medication? Does the dosage have any effect? My husband takes 50 mg and is well. However, he does have pain in his legs and we aren't sure if there is a connection there. It would be interesting to take a survey about the dosage, region and ages of the patients.

This is for e.r. with the itchy scalp rash. I had one for decades on my arms that no dermatologist could diagnose nor treat successfully. Finally I found a site where someone used lecithin and flaxseed oil capsules. The two taken daily worked for me. Thank the lord for the internet!!!

I am on Metoprolo Succinate ER 24 HR 25 MG. Am I in danger for taking this-- I just had a pace maker put in a month ago- don't have a clue as to what is going on. please and thank you.

I was wondering if anyone has had any problems with generic Propranolol, namely Actavis manufacturer? After about 12 years of being on Propranolol ER 80 mg. for BP and heart palps, my recent refill was by Actavis. My blood pressure started running high, I have shortness of breath and heart palps. I came to the conclusion that something was lacking with the medication and when I checked, the new refill and the problematic symptoms coincided. Any one else have this problem? BTW, I had taken the generic form of this medication for a long time.....just never this particular manufacturer.

I have been on Atenolol for about 25 years. Oh boy I am suffering very much. I complaint to my doctor all the time. He says he's not taking me off of the Atenolol. My hair has all came out, I don't look the same anymore. I feel drugged all the time, sleepy, depressed, memory loss, bad dreams, you name it.

The doctor changed my dose from 50mg twice per day to 25mg twice per day, that didn't help any at all. I have high blood pressure. It seems to me that there should be some other medication for high BP except Atenolol.

I have been on a calcium channel blocker (Cardizem CD) twice a day for about three years. Prior to that I was on atenolol, not for hypertension but as adjunctive therapy for my chronic A-fib.

I do have the infrequent cough which I relate to the use of a CCB. However, my hair is thinning significantly. Has anyone else taking a calcium channel blocker experienced this problem?

I am a 76 year old male and on 25 mg Atenolol since 1985 and main side effects I have noticed are the enlargement in chest and impotence. Also take 2.5 amlodipine once a day. For last 3 years my creatine level (fasting) is gradually increasing from 1.25 to 1.75. Is it advisable to stop atenolol and may be switch to Coreg? I usually get my blood work monitored by my family physician every 3 months. Please advise.

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