Beta-blockers will be discussed here primarily for the purpose of complementing the primary physician’s care. Beta blockers have become a modern necessary treatment for patients with hypertension and cardiovascular disease. This class of medications work by competing with epinephrine (a.k.a. adrenaline) for beta-adrenergic receptors which reduces stress on the heart. By blocking beta receptors in the blood vessels, beta blockers reduce blood pressure. Beta blockers also block beta receptors in the heart to slow heart rate, reduce the heart’s strength of contraction, and reduce the oxygen required by the heart. Examples of commonly used beta blockers include: atenolol, carvedilol, labetalol, nadolol, metoprolol, propranolol, sotalol. The adverse effects of Beta blocker use, herb interactions, as well as the effects of beta-blocker use with exercise will be discussed.
Use of beta-blockers and adverse effects:
The use of beta blockers is a standard of care in modern medicine for treatment of hypertension and systolic heart failure. Beta-blockers reduce morbidity, decrease mortality, and are recommended in all patients with systolic heart failure by the American College of Cardiology and American Heart Association (1). Upon starting on a beta blocker, education is required regarding potential adverse effects. Depression, slow heart rate, fatigue, insomnia, dizziness, reduced libido, high potassium levels, itching, and insomnia are a few of the common ones. If any of these symptoms occur, (especially slow heart rate under 50 beats per minute and dizziness), it is important to discuss them with your primary care provider or contact emergency services. Orange juice contains hesperidin which was found to decrease the absorption of beta blockers (3).
Herbal products, beta-blockers, and blood pressure medication:
Herbal products which may have additive effects to blood pressure medication include ephedra, beet root, coenzyme Q10, cocoa, chocolate, ginseng, ginger, gotu cola, black cohosh, yohimbe, hawthorne, goldenseal, cayenne, hibiscus, and quinine (found in drinks made with tonic carbonated water). Licorice may increase blood pressure.
Beta-blocker effect on exercise:
For patients who exercise, beta-blockers decrease heart rate and blood pressure during rest and exercise. Beta blockers will increase baseline exercise capacity in patients with pre-existing angina and will either decrease or have no affect on those patients without angina (2).
Beta-blockers and insomnia:
Patients who develop insomnia while taking beta blockers may benefit from melatonin. A 3-week nightly 2.5 mg melatonin supplementation in 16 individuals with high blood pressure who were taking beta-blockers suggested that melatonin supplementation increased sleep quality. After 3 weeks, individuals on melatonin significantly increased total sleep time by 36 minutes, increased sleep efficiency by 7%, reduced time to reach a light sleep (stage 2) by 14 minutes, and increased time spent in Stage 2 sleep by 41 minutes when compared to the placebo group. A significantly reduced time to reach a light sleep (-25 minutes) continued for a day after supplementation stopped suggesting the benefit of melatonin may have still been present. (4)
Conclusion: Beta-blockers
- Beta-blockers reduce morbidity, decrease mortality, and unless contraindicated, are recommended in all patients with systolic heart failure by the American College of Cardiology and American Heart Association (1).
- Call your health provider for bradycardia (slow heart rate) under 50 beats per minute or dizziness. Other common adverse effects with beta-blocker use include depression, fatigue, insomnia, dizziness, reduced libido, high potassium levels, itching, and insomnia.
- Orange juice contains hesperidin which was found to decrease the absorption of beta blockers (3).
- Herbal products which have additive effects to blood pressure medication include ephedra, beet root, coenzyme Q10, cocoa, chocolate, ginseng, ginger, gotu cola, black cohosh, yohimbe, hawthorne, goldenseal, cayenne, hibiscus, and quinine (found in drinks made with tonic carbonated water). Licorice may increase blood pressure.
- For patients who exercise, beta-blockers decrease heart rate and blood pressure during rest and exercise. Beta blockers will increase baseline exercise capacity in patients with pre-existing angina and will either decrease or have no affect on those patients without angina (2). In other words, they improve one’s ability to tolerate exercise.
- After 3 weeks, individuals on 2.5g melatonin significantly increased total sleep time by 36 minutes, sleep efficiency, lowered time to reach a light sleep when compared to the placebo group (4).
References :
1.Pritchett AM, Redfield MM. Mayo Clin Proc. Beta-blockers: new standard therapy for heart failure. 2002 Aug;77(8):839-45; quiz 845-6. http://www.ncbi.nlm.nih.gov/pubmed/12173717
2.Gauer RL, O\’Connor FG. Department of Family Medicine Uniformed Services University of the Health Sciences. How To Write And Exercise Prescription. http://www.move.va.gov/download/Resources/CHPPM_How_To_Write_And_Exercise_Prescription.pdf
3.Uesawa Y, Mohri K. Hesperidin in orange juice reduces the absorption of celiprolol in rats. Biopharm Drug Dispos. Source Department of Pharmaceutics, Meiji Pharmaceutical University, 2-522-1, Noshio, Kiyose, Tokyo 204-8588, Japan. 2008 Apr;29(3):185-8. doi: 10.1002/bdd.603. http://www.ncbi.nlm.nih.gov/pubmed/18344215
4.Scheer FA, Morris CJ, Garcia JI, Smales C, Kelly EE, Marks J, Malhotra A, Shea SA. Repeated melatonin supplementation improves sleep in hypertensive patients treated with beta-blockers: a randomized controlled trial. Sleep. 2012 Oct 1;35(10):1395-402. http://www.ncbi.nlm.nih.gov/pubmed/23024438