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Beta-Blocker

Beta-Blockers: What They Do and Who Needs Them

Beta-blockers slow the heart and reduce its workload. They are essential medications after heart attacks, in heart failure, and for controlling abnormal heart rhythms.

Written and clinically reviewed by Suman Konda, PharmD, Clinical Pharmacist · Editorial policy · Not medical advice

Last reviewed and updated: · How we check our content

Main uses
Heart failure, AF, angina
Effect
Slows heart rate
Key check
Pulse rate
Don't stop
Abruptly: dangerous

Common Beta-Blockers and Their Uses

DrugMain IndicationsNotes
BisoprololHeart failure, AF rate controlMost cardioselective: least breathlessness
AtenololHypertension, anginaOnce daily, widely used
MetoprololHypertension, angina, heart failureUsed in USA predominantly
PropranololAnxiety, migraine prevention, thyrotoxicosisNon-selective: avoid in asthma
CarvedilolHeart failureAlso an alpha-blocker
LabetalolHypertension in pregnancySafe in pregnancy: alpha+beta blocker
Never Stop AbruptlyStopping beta-blockers suddenly, especially after a heart attack or in heart failure, can trigger dangerous rebound: severe hypertension, angina, or heart attack. Always taper the dose gradually under doctor supervision.

Side Effects

  • Fatigue and tiredness: very common
  • Cold hands and feet
  • Slower heart rate (bradycardia): pulse <50 bpm needs medical review
  • Worsening breathlessness (especially in asthma)
  • Vivid dreams / nightmares (especially propranolol)
  • Erectile dysfunction
  • Masks hypoglycaemia symptoms in diabetics
Asthma and Beta-BlockersNon-selective beta-blockers (propranolol, carvedilol) are contraindicated in asthma. Cardioselective ones (bisoprolol, atenolol) are used with caution if absolutely necessary: always discuss with your doctor.

Monitoring on Beta-Blockers

CheckFrequencyTarget
Resting heart rateAt each visit or at homeUsually 50–65 bpm in heart failure
Blood pressureRegular home monitoring<130/80 mmHg
Symptoms of breathlessnessEvery visitEnsure not worsening asthma/COPD
Blood glucose (diabetics)RegularBeta-blockers can mask hypo symptoms
Can I take beta-blockers if I have COPD?
Cardioselective beta-blockers (bisoprolol, atenolol) are generally safe in COPD at low doses, and the cardiac benefit often outweighs the risk. Non-selective ones should be avoided.
Beta-blockers and exercise: will I be limited?
Beta-blockers limit maximum heart rate, which reduces exercise capacity. Most people can still exercise normally at a moderate level. Your cardiologist may adjust the dose to allow better exercise tolerance.
Does propranolol help anxiety?
Yes. Propranolol blocks the physical symptoms of anxiety (racing heart, tremor, sweating) without sedation. It's commonly used for situational anxiety (e.g. performance anxiety, public speaking).
HypertensionBlood pressure management

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Medical Disclaimer: This page is for general education only and does not replace professional medical advice. Always consult a qualified healthcare provider.