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ACE Inhibitors vs. Beta Blockers
- ACE inhibitors (angiotensin converting enzyme inhibitors) and beta blockers are used to treat high blood pressure (hypertension) and congestive heart failure, to prevent kidney failure in patients with high blood pressure or diabetes, and to reduce the risk of stroke.
- ACE inhibitors are also used to improve survival after heart attacks.
- Beta-blockers are also used to treat abnormal heart rhythms, chest pain (angina), tremors, pheochromocytoma, hypertrophic subaortic stenosis, and to prevent migraines.
- Examples of ACE Inhibitors include benazepril hydrochloride (Lotensin), captopril (Capoten), enalapril maleate (Vasotec), fosinopril sodium (monopril), lisinopril (Prinivel, Zestril), moexipril (Univasc), moexipril (Univasc), perindopril (Aceon), quinapril hydrochloride (Accupril), ramipril (Altace), and trandolapril (Mavik).
- Examples of beta-blockers include acebutolol (Sectral), atenolol (Tenormin), betaxolol (Kerlone), bisoprolol fumarate (Zebeta), carteolol hydrochloride (Cartrol), metoprolol tartrate (Lopressor), metoprolol succinate (Toprol-XL), nadolol (Corgard), penbutolol sulfate (Levatol), pindolol (Visken), propranolol hydrochloride (Inderal), solotol hydrochloride (Betapace), and timolol maleate (Blocadren).
- Common side effects of ACE inhibitors include:
- Skin rash
- Changes in taste
- Serious side effects of ACE inhibitors include:
- Swelling (angioedema) of face, mouth, throat, airway
- Common side effects of beta-blockers include:
- Cold hands and feet
- Tiredness or depression
- Slow heartbeat
- Symptoms of asthma
- Both ACE inhibitors and beta-blockers are not recommended for use during pregnancy. They may cause low blood pressure, excess potassium in the blood (hyperkalemia), kidney failure, and harm to a fetus.
Quick GuideHow to Lower Blood Pressure: Exercise Tips
What are ACE Inhibitors and Beta-Blockers?
ACE inhibitors (angiotensin converting enzyme inhibitors) work by preventing a natural body substance called angiotensin I from converting into angiotensin II, which cases blood vessels to narrow and constrict. By preventing this change, the blood vessels remain relaxed and blood pressure decreases.
Beta-blockers, also known as beta-adrenergic blocking agents, block norepinephrine and epinephrine (adrenaline) from binding to beta receptors on nerves. This helps reduce the heart rate and lower blood pressure.
What are the side effects of ACE inhibitors and Beta blockers?
ACE inhibitors are well-tolerated by most individuals. Nevertheless, they are not free of side effects, and some patients should not use ACE inhibitors. ACE inhibitors usually are not prescribed for pregnant women because they may cause birth defects.
Individuals with bilateral renal artery stenosis (narrowing of the arteries that supply the kidneys) may experience worsening of kidney function, and people who have had a severe reaction to ACE inhibitors probably should avoid them.
The most common side effects are:
- Elevated blood potassium levels
- Low blood pressure,
- Abnormal taste (metallic or salty taste)
- Chest pain
- Increased uric acid levels
- Sun sensitivity
- Increased BUN and creatinine levels
It may take up to a month for coughing to subside, and if one ACE inhibitor causes cough it is likely that the others will too. The most serious, but rare, side effects of ACE inhibitors are:
- Kidney failure
- Allergic reactions
- Liver dysfunction
- A decrease in white blood cells
- Swelling of tissues (angioedema).
Beta blockers may cause:
- Stomach cramps
Other important side effects include:
- Blurred vision
- Hair loss
- Muscle cramps
As an extension of their beneficial effect, they slow heart rate and reduce blood pressure, but they may cause adverse effects such as heart failure or heart block in patients with heart problems.
Beta blockers should not be withdrawn suddenly because sudden withdrawal may worsen angina (chest pain) and cause heart attacks, serious abnormal heart rhythms, or sudden death.
- Central nervous system effects of beta blockers include:
Beta blockers that block β2 receptors may cause shortness of breath in asthmatics. As with other drugs used for treating high blood pressure, sexual dysfunction may occur. Beta blockers may cause low or high blood glucose and mask the symptoms of low blood glucose (hypoglycemia) in people with diabetes.
Other serious side effects of beta-blockers include:
- Toxic epidermal necrolysis
- Raynaud's phenomenon
- Lupus erythematosus
- Serious allergic reactions
- Erythema multiform
- Steven Johnson Syndrome
- Toxic epidermal necrolysis
What are the drugs that interact with ACE inhibitors and Beta blockers?
ACE inhibitors have few interactions with other drugs.
- Since ACE inhibitors may increase blood levels of potassium, the use of potassium supplements, salt substitutes (which often contain potassium), or other drugs that increase the body's potassium may result in excessive blood potassium levels.
- ACE inhibitors also may increase the blood concentration of lithium (Eskalith, Lithobid) and lead to an increase in side effects from lithium.
- There have been reports that aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen (Advil, Children's Advil/Motrin, Medipren, Motrin, Nuprin, PediaCare Fever etc.), indomethacin (Indocin, Indocin-SR), and naproxen (Anaprox, Naprelan, Naprosyn, Aleve) may reduce the blood pressure lowering effects of ACE inhibitors.
- Patients receiving diuretics may experience excessive reduction in blood pressure when ACE inhibitors are started. Stopping the diuretic or increasing salt intake prior to taking the ACE inhibitor may prevent excessive blood pressure reduction. Close supervision for at least two hours after the start of ACE inhibitors and until blood pressure is stable is recommended if the diuretic cannot be stopped.
- ACE inhibitors should not be combined with ARBs because such combinations increase the risk of hypotension, hyperkalemia, and renal impairment.
- ACE inhibitors should not be combined with aliskiren (Tekturna), another class of drugs that is used to treat high blood pressure because such combinations increase the risk of kidney failure, excessive low blood pressure, and hyperkalemia.
- Nitritoid reactions (symptoms include facial flushing, nausea, vomiting and low blood pressure) may occur when injectable (gold sodium aurothiomalate [Myochrysine]), used in the treatment of rheumatoid arthritis, is combined with ACE inhibitors.
- Combining propranolol (Inderal) or pindolol (Visken) with thioridazine (Mellaril) or chlorpromazine (Thorazine) may result in low blood pressure (hypotension) and abnormal heart rhythms because the drugs interfere with each other's elimination and result in increased levels of the drugs.
- Dangerous elevations in blood pressure may occur when clonidine (Catapres) is combined with a beta blocker, or when clonidine or beta blocker is discontinued after their concurrent use. Blood pressure should be closely monitored after initiation or discontinuation of clonidine or a beta blocker when they have been used together.
- Phenobarbital and similar agents may increase the breakdown and reduce blood levels of propanolol (Inderal) or metoprolol (Lopressor, Toprol XL). This may reduce effectiveness of the beta blocker.
- Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) (for example, ibuprofen) may counteract the blood pressure reducing effects of beta blockers by reducing the effects of prostaglandins, which play a role in control of blood pressure.
- Beta blockers may prolong hypoglycemia (low blood sugar) and mask symptoms of hypoglycemia in diabetics who are taking insulin or other diabetic medications.
What are the different types of ACE inhibitors and Beta blockers?
The following is a list of the ACE inhibitors that are available in the United States:
- benazepril (Lotensin)
- captopril (Capoten- discontinued brand)
- enalapril (Vasotec, Epaned, [Lexxel- discontinued brand])
- fosinopril (Monopril- Discontinued brand)
- lisinopril (Prinivil, Zestril, Qbrelis)
- moexipril (Univasc- Discontinued brand)
- perindopril (Aceon)
- quinapril (Accupril)
- ramipril (Altace)
- trandolapril (Mavik)
The following is a list of the Beta blockers that are available in the United States:
- acebutolol (Sectral)
- atenolol (Tenormin)
- betaxolol (Kerlone)
- betaxolol (Betoptic S)
- bisoprolol fumarate (Zebeta)
- carteolol (Cartrol, discontinued)
- carvedilol (Coreg)
- esmolol (Brevibloc)
- labetalol (Trandate [Normodyne - discontinued])
- metoprolol (Lopressor, Toprol XL)
- nadolol (Corgard)
- nebivolol (Bystolic)
- penbutolol (Levatol)
- pindolol (Visken, discontinued)
- propranolol (Hemangeol, Inderal LA, Inderal XL, InnoPran XL)
- sotalol (Betapace, Sorine)
- timolol (Blocadren, discontinued)
- timolol ophthalmic solution (Timoptic, Betimol, Istalol)
ACE inhibitors (angiotensin converting enzyme inhibitors) and beta-blockers are used to treat high blood pressure (hypertension) and congestive heart failure, to prevent kidney failure in patients with high blood pressure or diabetes, and to reduce the risk of stroke. Learn more about the side effects and drug interaction for these drug classes.
Multimedia: Slideshows, Images & Quizzes
High Blood Pressure (Hypertension) Quiz: Symptoms, Signs & Causes
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Treatment & Diagnosis
Medications & Supplements
- quinapril - oral, Accupril
- atenolol - oral, Tenormin
- quinapril, Accupril
- ramipril, Altace
- captopril, Capoten
- nadolol (Corgard)
- metoprolol (Lopressor, Toprol XL)
- benazepril (Lotensin HTC)
- fosinopril sodium, Monopril
- enalapril, Vasotec, Epaned
- lisinopril (Zestril, Prinivil, Qbrelis) ACE Inhibitor
- atenolol and chlorthalidone, Tenoretic
- betaxolol ophthalmic, Betoptic S, Betoptic
- carvedilol (Coreg, Coreg CR)
- labetalol, Normodyne, Trandate
- trandolapril, Mavik
- moexipril - oral, Univasc
- carteolol solution - ophthalmic, Ocupress
- perindopril - oral, Aceon
Quick GuideHow to Lower Blood Pressure: Exercise Tips
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Heart Health Resources
Subscribe to MedicineNet's Heart Health Newsletter
Report Problems to the Food and Drug Administration
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.
American Heart Association
FDA Prescribing information
Top ACE Inhibitors vs Beta Blockers Related Articles
atenolol and chlorthalidoneAtenolol and chlorthalidone (Tenoretic) is a combination drug prescribed to treat high blood pressure and abnormally rapid heart rhythms. Side effects, drug interactions, storage, dosing, and pregnancy asfety information should be reviewed prior to taking this medication.
benazeprilBenazepril (Lotensin) is a medication prescribed alone or in combination with hydrochlorothiazide for treating high blood pressure. Off label uses for Lotensin include treatment for heart failure or diabetic neuropathy. Side effects, drug interactions, dosing, and pregnancy and breastfeeding safety should be reviewed prior to taking this medication.
captoprilCaptopril (Capoten) is an ACE inhibitor prescribed for the treatment of high blood pressure, heart failure, and prevention of kidney failure due to high blood pressure and diabetes. Side effects, drug interactions, warnings and precautions, and efficacy during pregnancy information should be reviewed prior to taking this medication.
enalaprilEnalapril (Vasotec, Epaned) is a drug that belongs to the drug class of Ace inhibitors. Enalapril is prescribed for the treatment of high blood pressure. Side effects, drug interactions, warnings and precautions, and use during pregnancy should be reviewed prior to taking any medication.
fosinopril sodiumFosinopril sodium (Monopril) is an ACE inhibitor drug prescribed for the treatment of high blood pressure, congestive heart failure, and post-heart attack treatment. Side effects, drug interactions, warnings and precautions, and patient safety information should be reviewed prior to taking any medication.
High Blood Pressure Hypertension
High blood pressure (hypertension) is a disease in which pressure within the arteries of the body is elevated. About 75 million people in the US have hypertension (1 in 3 adults), and only half of them are able to manage it. Many people do not know that they have high blood pressure because it often has no has no warning signs or symptoms.
Systolic and diastolic are the two readings in which blood pressure is measured. The American College of Cardiology released new guidelines for high blood pressure in 2017. The guidelines now state that blood normal blood pressure is 120/80 mmHg. If either one of those numbers is higher, you have high blood pressure.
The American Academy of Cardiology defines high blood pressure slightly differently. The AAC considers 130/80 mm Hg. or greater (either number) stage 1 hypertension. Stage 2 hypertension is considered 140/90 mm Hg. or greater.
If you have high blood pressure you are at risk of developing life threatening diseases like stroke and heart attack.
REFERENCE: CDC. High Blood Pressure. Updated: Nov 13, 2017.
Take the HBP QuizTake this quiz and test your IQ of high blood pressure (hypertension), the cardiovascular disease that causes most strokes and heart attacks. How are dizziness, snoring, and gout related to HBP? Find the answer and learn how medical treatments and lifestyle adjustments fight this common problem.
Hypertension PictureHigh blood pressure, defined as a repeatedly elevated blood pressure exceeding 140 over 90 mmHg -- a systolic pressure above 140 with a diastolic pressure above 90. See a picture of Hypertension and learn more about the health topic.
Kidney Disease (Hypertension-Related)High blood pressure can damage the kidneys and is one of the leading causes of kidney failure (end-stage renal kidney disease). Kidney damage, like hypertension, can be unnoticeable and detected only through medical tests. If you have kidney disease, you should control your blood pressure. Other treatment options include prescription medications.
Lisinopril (Zestril, Prinivil, Qbrelis) is an ACE inhibitor prescribed for the treatment of:
- High blood pressure
- Heart failure
- Heart attack survival
- Preventing kidney failure due to high blood pressure
Side effects are, nasal congestion, anxiety, headaches, insomnia, drowsiness, and nausea. ACE inhibitors may cause a nonproductive cough that resolves once you stop taking the drug. Drug interactions include potassium supplements or derivatives of potassium, lithium (Eskalith, Lithobid), nonsteroidal anti-inflammatory drugs (aspirin, ibuprofen, naproxen), and symptoms of flushing; high blood pressure; nausea; and vomiting. Warnings and precautions, pregnancy information, and other safety information should be reviewed prior to taking any medication.
If you notice other effects not listed above, contact your doctor or pharmacist. In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
Metoprolol (Lopressor, Toprol XL) is a beta-adrenergic blocking agent drug, which blocks the action of the sympathetic nervous system (a portion of the involuntary nervous system). Metoprolol is prescribed to treat high blood pressure (hypertension), heart pain (angina), heart rhythm disorders, and some neurological conditions. Side effects include:
- Sore throat
- Memory loss
- High blood pressure
Drug interactions, dosing, and pregnancy and breastfeeding safety should be reviewed prior to taking any medication.
nadololNadolol (Corgard) is in the drug class of beta blockers and is prescribed for the treatment of angina (heart pain, chest pain), high blood pressure, abnormal heart rhythms, tremor, and the prevention of headaches and anxiety. Side effects, drug interactions, warnings and precautions, and safety during pregnancy information should be reviewed prior to taking this medication.
Portal HypertensionPortal hypertension is most commonly caused by cirrhosis, a disease in which results from scarring of a liver injury. Other causes of portal hypertension include:
- blood clots in the portal vein,
- blockages of the veins that carry the blood from the liver to the heart, and
- a parasitic infection called schistosomiasis.
- varices (enlarged veins),
- vomiting blood and blood in the stool.
- black, tarry stool,
- ascites (abnormal fluid collection within the peritoneum, the sac that contains the intestines within the abdominal cavity),
- confusion and lethargy,
- splenomegaly or enlargement of the spleen, and
- decreased white blood cell counts.
Pregnancy Induced HypertensionPreeclampsia is related to increased blood pressure and protein in the mother's urine. Preeclampsia typically begins after the 20th week of pregnancy. When preeclampsia causes seizures, it is termed "eclampsia" and is the second leading cause of maternal death of in the US. Preeclampsia is the leading cause of fetal complications. Risk factors for preeclampsia include high blood pressure, obesity, multiple births, and women with preexisting medical conditions such as diabetes, kidney disease, rheumatoid arthritis, lupus, or scleroderma. Pregnancy planning and lifestyle changes may reduce the risk of preeclampsia during pregnancy.
Pulmonary hypertension is an increase pressure in the pulmonary arteries that carry blood from the lungs to the heart. The most common symptoms are fatigue and difficulty breathing. If the condition goes undiagnosed, more severe symptoms may occur, for example:
- Ankle swelling (edema)
- Heart palpitations
- Chest pain
- Decreased appetite
- Pain in the upper right side of the belly (abdomen)
- Fainting (syncope)
- Lightheadedness, particularly during physical activity
- Swelling in the legs and ankles
- A bluish color to the lips and skin
People at risk of developing pulmonary hypertension are those who:
- Live at high altitudes
- Have a family history of the condition.
- Have diseases and conditions that may put them at risk of developing pulmonary hypertension
- Use illegal drugs like cocaine, and certain diet drugs.
NIH. National Heart, Lung, and Blood Institute. "What is Pulmonary Hypertension?" Updated: Aug 2011
NIH. PubMed Health. "Pulmonary Hypertension (PH)."
CDC. Division for Heart Disease and Stroke Prevention. "Pulmonary Hypertension Fact Sheet." Updated: Jul 22, 2014.
quinaprilQuinapril (Accupril) is a medication prescribed to use in combination with other medications to treat high blood pressure and heart failure. Side effects, drug interactions, storage, dosage, and pregnancy safety information should be reviewed prior to taking any medication.
ramiprilramipril (Altace) is an ACE inhibitor drug prescribed for the treatment of congestive heart failure and high blood pressure. Altace also prevents heart attacks, strokes, and deaths due to heart disease in individuals at risk for these diseases. Side effects, multiple drug interactions, dosage, and pregnancy safety should be reviewed prior to taking this medication.