Beta-Blockers
Beta-blockers affect the force and frequency of heart beats; they slow certain metabolic processes, ease the workload of the heart, and reduce pressure. They are very effective, and currently recommended along with or instead of diuretics as initial treatment. Beta-blockers have been associated with a lower risk for a second heart attack or sudden death after a first heart attack, although one recent study indicated that beta-blockers did not reduce mortality rates in people over 60 years old. More research is needed on this surprising result. These drugs are not as effective as ACE inhibitors in people with or at risk for kidney disease. Because they can narrow bronchial airways and constrict blood vessels, patients with asthma should avoid them whenever possible. Many beta-blockers are now available, including propranolol (Inderal), acebutolol (Sectral), atenolol (Tenormin), betaxolol (Kerlone), carteolol (Cartrol), metoprolol (Lopressor), nadolol (Corgard), penbutolol (Levatol), pindolol (Visken), and timolol (Blocadren). The drugs may differ in their effects and benefits. Carvedilol (Coreg), which is a mild beta-blocker with some vasodilating properties has been found to improve very severe heart failure. It also appears to have a better effect on insulin sensitivity than other beta-blockers and so may prove to be a good choice for people with diabetes. A similar drug, bucindol, is in development. Atenolol has been found to reduce left ventricular hypertrophy and, when used with the diuretic chlorthalidone, was found to significantly reduce the risk for heart failure, particular in patients at high risk for it.
Some beta-blockers tend to lower HDL cholesterol (the beneficial cholesterol) by about 10%; the effect is most marked in smokers. Fatigue and lethargy are the most common psychologic side effects. Some people experience vivid dreams and nightmares, depression, and memory loss. Exercise capacity may be reduced. Other side effects may include cold extremities, asthma, decreased heart function, gastrointestinal problems, and sexual dysfunction. If side effects occur, the patient should call a physician, but it is extremely important not to stop the drug abruptly. Angina, heart attack, and even sudden death have occurred in patients who discontinued treatment without gradual withdrawal.
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