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The Beta Blocker Blahs Can Be Debilitating

Beta blockers like atenolol, metoprolol and propranolol used to be very popular BP drugs. But the beta blocker blahs can be problematic. What else works?

Beta blockers are blood pressure medications that have been around for many decades. They include drugs like atenolol (Tenormin), metoprolol (Toprol) and propranolol (Inderal). In some instances, such as hypertrophic cardiomyopathy, metoprolol can be essential. For a long time, such drugs were first-line approaches for treating hypertension. However, there is now some doubt about the wisdom of this approach (Pharmacological Research, Jan. 2020). For one thing,  people often complain of the beta blocker blahs or the beta blocker blues.

The Beta Blocker Blahs in Real Life:

Q. Thank you for writing about beta blockers making you feel like rubbish. I was diagnosed with high blood pressure eight years ago (140/80). My doctor prescribed atenolol.

It did NOTHING for my blood pressure, so after a couple of months my GP added perindopril. WOW! My blood pressure went to 120/70 in two days.

In the meantime, my heart rate that was formerly 80 or 90 BPM was now at 60 or less. Any task was so tiring! I have now passed 60 years of age and I could barely split wood.

When I realized this might be due to the atenolol, I halved the dose for two weeks, then halved it again for another two weeks. Now, a month later, my resting heart rate is back to 80. My blood pressure is 125/75 thanks to the perindopril. I can split wood, walk and even run again. For the past eight years on the beta blocker, I felt like I would pass out if I tried to run. Cheers from Australia.

The Beta Blocker Blahs Can Slow You Down:

A. You are not the first person to complain about the beta blocker blahs. One man reported that atenolol brought his blood pressure down to 130/63 but left him feeling “extremely fatigued.”

Another blamed metoprolol for his “fatigue, tiredness, blahs and depression.”

A woman in Texas complained about propranolol. She said it took away all motivation to work, cook or interact with others. After six months she was really depressed. She asked the nurse in her cardiologist’s office if the propranolol could be part of the problem. The answer: “unlikely.”

When Jasmine saw her cardiologist he said that depression is a common side effect of beta blockers. Not surprisingly, Jasmine was more than a little annoyed that no one bothered to mention that before prescribing a beta blocker.

Another reader offered this testimonial:

Q. I had been taking atenolol for several years when it became unavailable. My doctor switched the prescription to metoprolol.

After taking it for about six months, I realized I was feeling depressed. I asked my cardiologist if it could be the metoprolol. He said definitely because that med crosses the blood/brain barrier.

Fortunately, atenolol is available now, so I am taking it again and doing fine. My blood pressure is very well controlled.

A. Metoprolol has a greater affinity for brain tissue than atenolol. This might explain your experience with depression (Pharmacology & Therapeutics, 1990, vol. 46, no. 2).  Other side effects of beta blockers like atenolol, metoprolol or propranolol include sleep disturbances and nightmares as well as fatigue, cold hands and feet, shortness of breath and slow heart rate.

Learn more about the beta blocker blahs at this link:

Is Your Blood Pressure Medicine Making You Sad and Depressed?

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Never Stop a Beta Blocker Suddenly!

We always worry that abrupt discontinuation of a beta blocker could lead to serious heart complications. If the prescriber agrees that a beta blocker should be discontinued, then it should be done gradually under medical supervision.

Find out why beta blockers are no longer considered first line treatments for hypertension at this link:

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

What About Perindopril (Aceon)?

Perindopril (Aceon) is an ACE inhibitor and is considered a first-line blood pressure treatment. Beta blockers, on the other hand, are no longer deemed the best choice for blood pressure control. They can cause fatigue and slow heart rate.

You can learn more about these medications and other approaches to manage hypertension in our Guide to Blood Pressure treatment. It is available in the health guide section.

Share your own story about blood pressure treatment in the comment section. Have you ever experienced the beta blocker blahs? What was that like?

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.”.
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  • Fumagalli C et al, "β-blockers: Their new life from hypertension to cancer and migraine." Pharmacological Research, Jan. 2020. DOI: 10.1016/j.phrs.2019.104587
  • McAinsh J & Cruickshank JM, "Beta-blockers and central nervous system side effects." Pharmacology & Therapeutics, 1990, vol. 46, no. 2. DOI: 10.1016/0163-7258(90)90092-g
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