Which medications in the drug class Beta-Blockers, Beta-1 Selective are used in the treatment of Hypertension?

Updated: Feb 22, 2019
  • Author: Matthew R Alexander, MD, PhD; Chief Editor: Eric H Yang, MD  more...
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Answer

Beta-Blockers, Beta-1 Selective

Beta-blockers are generally not recommended as first-line agents for the treatment of hypertension; however, they are suitable alternatives when a compelling cardiac indication (eg, heart failure, myocardial infarction, diabetes) is present. Selective beta-blockers specifically block beta-1 receptors alone, although they can be nonselective at higher doses.

Caution should be used in administering these agents in the setting of asthma or severe chronic obstructive pulmonary disease (COPD), regardless of beta-selectivity profile. In addition, exacerbations of angina and, in some cases, myocardial infarction have been reported following abrupt discontinuance of beta-blocker therapy. The doses should be gradually reduced over at least a few weeks.

Atenolol (Tenormin)

Atenolol is approved for the management of hypertension used alone or concomitantly with other antihypertensive agents, particularly with a thiazide-type diuretic. The initial dose is 50 mg daily, alone or added to diuretic therapy. If adequate clinical effect is not seen, the dose can be titrated to 100 mg daily. Other studies suggest that atenolol lacks specific potential for stroke reduction.

Metoprolol (Lopressor, Toprol XL)

Metoprolol is approved for the management of hypertension alone or concomitantly with other antihypertensive agents. The initial dose for metoprolol immediate release is 100 mg daily in single or divided doses, with or without a diuretic (maximum 450 mg/day). Metoprolol extended-release formulation can be started at a dose of 25-100 mg daily in a single dose, with or without a diuretic (maximum 400 mg/day).

Propranolol (Inderal LA, InnoPran XL)

Propranolol is approved for the management of hypertension alone or concomitantly with other antihypertensive agents. The initial dose is 40 mg given twice daily, alone or added to diuretic therapy. Dose can be titrated based on a patient's clinical response. The maintenance dose can range from 120-240 mg/day (maximum 640 mg/day). Exacerbations of angina and, in some cases, myocardial infarction, following abrupt discontinuance of propranolol therapy have been reported. The propranolol dose should be gradually reduced over at least a few weeks.

Bisoprolol (Zebeta)

Bisoprolol is approved for the management of hypertension alone or in combination with other antihypertensive agents. This agent is a more specific beta-1 blocker than other beta-blockers. The initial dose is 5 mg once daily (reduce to 2.5 mg for patients with bronchospastic disease). The dosage can be titrated to 10 mg/day and then to 20 mg/day if necessary.

Timolol

Timolol is indicated for the treatment of hypertension. It is used alone or in combination with other antihypertensive agents, especially thiazide-type diuretics. The initial dose is 10 mg given twice daily. The total daily dose can be titrated to a maximum of 30 mg administered in divided doses. Avoid abrupt cessation of therapy, because of the risk of exacerbation of ischemic heart disease.


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