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What's the Difference between Beta Blockers and ARBs?
- Beta blockers and ARBs are used to treat high blood pressure and heart failure.
- Examples of beta blockers include acebutolol (Sectral), atenolol (Tenormin), betaxolol (Kerlone, Betoptic S), bisoprolol fumarate (Zebeta), carvedilol (Coreg), esmolol (Brevibloc), metoprolol (Lopressor, Toprol XL), nadolol (Corgard), nebivolol (Bystolic), penbutolol (Levatol), propranolol (Hemangeol, Inderal LA, Inderal XL, InnoPran XL), sotalol (Betapace, Sorine), and timolol ophthalmic (Timoptic, Betimol, Istalol).
- Examples of ARBs include azilsartan (Edarbi), candesartan (Atacand), eprosartan (Teveten), irbesartan (Avapro), telmisartan (Micardis), valsartan (Diovan), losartan (Cozaar), and olmesartan (Benicar).
- Side effects of beta blockers and ARBs that are similar include rash, diarrhea, and fatigue.
- Side effects of beta blockers that are different from ARBs include nausea, stomach cramps, vomiting, blurred vision, disorientation, insomnia, hair loss, weakness, muscle cramps, and sexual dysfunction.
- Side effects of ARBs that are different from beta blockers include cough, high blood potassium (hyperkalemia), low blood pressure, dizziness, headache, drowsiness, metallic or salty taste in the mouth, orthostatic hypotension (low blood pressure upon standing), indigestion, and upper respiratory tract infection.
- Sudden withdrawal from beta blockers may worsen angina (chest pain) and cause heart attacks, serious abnormal heart rhythms, or sudden death.
What Are Beta Blockers and ARBs?
Beta blockers, or beta-adrenergic blocking agents, block the neurotransmitters norepinephrine and epinephrine (adrenaline) from binding to beta-receptors on nerves. This helps dilate blood vessels, which results in a reduction of heart rate and blood pressure. Beta blockers are used to treat high blood pressure, angina (chest pain), heart failure, abnormal heart rhythms, tremors, pheochromocytoma, migraine headache prevention, hypertrophic subaortic stenosis, hyperthyroidism, panic disorder, anxiety, akathisia (restlessness or inability to sit still), eye pressure caused by glaucoma, and aggressive behavior. Beta blockers are also used to prevent future heart attacks and death after a heart attack.
Angiotensin II receptor blockers (ARBs) block the action of angiotensin II by preventing it from binding to receptors on the muscles surrounding blood vessels. Angiotensin II causes muscles surrounding blood vessels to contract, which increases pressure within the vessels and can cause high blood pressure (hypertension). When angiotensin II can’t bind to receptors, blood vessels enlarge (dilate) and blood pressure is reduced, making it easier for the heart to pump blood. ARBs are used to treat high blood pressure and heart failure, and to prevent kidney failure in people with diabetes or high blood pressure. ARBs are also used in patients with high blood pressure and an enlarged heart to prevent diabetes and reduce the risk of stroke. ARBs also may prevent atrial fibrillation from recurring.
Quick GuideHow to Lower Blood Pressure: Exercise Tips
What Are the Side Effects of Beta Blockers vs. ARBs?
Beta blockers may cause:
Other important side effects include:
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.
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.
- Raynaud's phenomenon
- Lupus erythematosus
- Serious allergic reactions
- Erythema multiform
- Steven Johnson Syndrome
- Toxic epidermal necrolysis
ARBs are well tolerated by most individuals. The most common side effects are
- elevated potassium levels in the blood (hyperkalemia),
- low blood pressure,
- abnormal taste sensation (metallic or salty taste),
- orthostatic hypotension (low blood pressure upon standing),
- indigestion, and
- upper respiratory tract infection.
Compared to ACE inhibitors, cough occurs less often with ARBs.
The most serious, but rare, side effects are
- kidney failure,
- liver failure (hepatitis),
- serious allergic reactions,
- a decrease in white blood cells,
- a decrease in blood platelets, and
- swelling of tissues (angioedema).
There have been reports of rhabdomyolysis (destruction of skeletal muscle) in patients receiving ARBs.
Individuals who have narrowing of both arteries that supply the kidneys or have had a severe reaction to ARBs should avoid them.
Like other antihypertensives, ARBs have been associated with sexual dysfunction.
What Drugs Interact with Beta Blockers and ARBs?
- 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.
- ARBs have few interactions with other drugs.
- Since ARBs may increase blood levels of potassium, the use of potassium supplements, salt substitutes (which often contain potassium), or other drugs that increase potassium may result in excessive blood potassium levels and cardiac arrhythmias.
- ARBs may also increase the blood concentration of lithium (Eskalith, Lithobid) and lead to an increase in side effects from lithium.
- Rifampin (Rifadin) reduces the blood levels of losartan, and fluconazole (Diflucan) reduces the conversion of losartan to its active form. These effects could decrease the effects of losartan.
- ARBs should not be combined with ACE inhibitors because such combinations increase the risk of hypotension, hyperkalemia, and renal impairment.
- ARBs should not be combined with aliskiren (Tekturna) because such combinations increase the risk of kidney failure, excessive low blood pressure, and hyperkalemia.
What Are the Different Types of Beta Blockers and ARBs?
- 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)
The following is a list of currently available ARBs:
- azilsartan (Edarbi)
- candesartan (Atacand),
- eprosartan (Teveten),
- irbesartan (Avapro),
- telmisartan (Micardis),
- valsartan (Diovan),
- losartan (Cozaar), and
- olmesartan (Benicar).
Both Beta blockers, or beta adrenergic blocking agents, and Angiotensin II receptor blockers (ARBs) both cause blood vessels to dilate through different actions on the nervous system. Beta blockers and ARBs are used to treat high blood pressure and heart failure.
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Medications & Supplements
- betaxolol suspension - ophthalmic, Betoptic S
- candesartan - oral, Atacand
- losartan/hydrochlorothiazide - oral, Hyzaar
- carvedilol - oral, Coreg
- atenolol - oral, Tenormin
- metoprolol/hydrochlorothiazide - oral, Lopressor HCT
- metoprolol - oral, Lopressor
- valsartan - oral, Diovan
- metoprolol extended-release - oral, Toprol XL
- telmisartan - oral, Micardis
- losartan - oral, Cozaar
- irbesartan - oral, Avapro
- METOPROLOL EXTENDED RELEASE-ORAL
- High Blood Pressure Drugs (Hypertension)
- losartan (Cozaar)
- irbesartan, Avapro
- candesartan cilexetil, Atacand
- metoprolol (Lopressor, Toprol XL)
- valsartan, Diovan
- telmisartan, Micardis
- carvedilol (Coreg, Coreg CR)
- atenolol, Tenormin
- losartan and hydrochlorothiazide, Hyzaar
- amlodipine and valsartan (Exforge)
- Coreg vs. Metoprolol Tartrate
- nadolol (Corgard)
- Sectral (acebutolol)
- valsartan/hydrochlorothiazide (Diovan HCT)
- Entresto (sacubitril and valsartan)
- atenolol and chlorthalidone, Tenoretic
- betaxolol, Kerlone (Discontinued Brand)
- betaxolol ophthalmic, Betoptic S, Betoptic
- irbesartan/hydrochlorothiazide - oral, Avalide
Heart Health Resources
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.
National Institutes of Health
FDA Prescribing Information
Top Beta-Blockers vs ARBs Related Articles
amlodipine and valsartanAmlodipine and valsartan (Exforge) is a combination of two medications prescribed for the treatment of high blood pressure (hypertension). Side effects, drug interactions, warnings and precautions should be reviewed prior to taking any medication.
atenololAtenolol (Tenormin)is a beta-adrenergic blocking agent, blocking the action of the sympathetic nervous system, a portion of the involuntary nervous system. Atenolol is prescribed for patients with high blood pressure (hypertension), used to treat chest pain (angina pectoris) related to coronary artery disease, and is also useful in slowing and regulating certain types of abnormally rapid heart rates (tachycardias). Other uses for atenolol include the prevention of migraine headaches and the treatment of certain types of tremors (familial or hereditary essential tremors). It is important to be aware of the drug interactions related to atenolol, effects on pregnancy, as well as common side effects on the user.
candesartanCandesartan cilexetil (Atacand) is a medication prescribed to treat high blood pressure. It is also used for reducing the chance of death or hospitalization due to heart failure. Side effects, drug interactions, warnings and precautions, and pregnancy safety should be reviewed prior to taking this medication.
carvedilolCarvedilol (Coreg, Coreg CR) drug prescribed to control high blood pressure in addition to a diuretic. Carvedilol also may be prescribed in addition with other drugs to manage mild to moderate congestive heart failure and heart disease for patients who have suffered a recent heart attack. Side effects, drug interactions, dosage, storage, and pregnancy safety information should be reviewed prior to taking this medication.
Congestive Heart Failure (CHF) OverviewCongestive heart failure (CHF) refers to a condition in which the heart loses the ability to function properly. Heart disease, high blood pressure, diabetes, myocarditis, and cardiomyopathies are just a few potential causes of congestive heart failure. Signs and symptoms of congestive heart failure may include fatigue, breathlessness, palpitations, angina, and edema. Physical examination, patient history, blood tests, and imaging tests are used to diagnose congestive heart failure. Treatment of heart failure consists of lifestyle modification and taking medications to decrease fluid in the body and ease the strain on the heart. The prognosis of a patient with congestive heart failure depends on the stage of the heart failure and the overall condition of the individual.
Heart failure (congestive) is caused by many conditions including coronary artery disease, heart attack, cardiomyopathy, and conditions that overwork the heart. Symptoms of heart failure include
- congested lungs,
- fluid and water retention,
- fatigue and weakness, and
- rapid or irregular heartbeats.
There are two types of congestive heart failure, systolic or left-sided heart failure; and diastolic or right-sided heart failure. Treatment, prognosis, and life-expectancy for a person with congestive heart failure depends upon the stage of the disease.
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.
High Blood Pressure Medication
High blood pressure (hypertension) medications include drugs from a variety of different drug classes and types.
- ACE inhibitors
- ARB (angiotensin receptor blockers)
- Beta blockers
- Calcium channel blockers (CCBs)
- Alpha-beta blockers
Clonidine (Catapres) and minoxidil also are drugs prescribed for the treatment of high blood pressure. Side effects, warnings and precautions, safety information, and pregnancy and breastfeeding safety information should be reviewed prior to taking any medication.
High Blood PressureWhat causes high blood pressure (hypertension)? Know the warning signs and symptoms of high blood pressure. Read about high blood pressure medications, diet, and long term treatments.
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.
High Blood Pressure TreatmentHigh blood pressure (hypertension) means high pressure (tension) in the arteries. Treatment for high blood pressure include lifestyle modifications (alcohol, smoking, coffee, salt, diet, exercise), drugs and medications such as ACE inhibitors, angiotensin receptor blockers, beta blockers, diuretics, calcium channel blockers (CCBs), alpha blockers, clonidine, minoxidil, and Exforge.
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.
irbesartanIrbesartan (Avapro) is a drug prescribed to treat high blood pressure and diabetic nephropathy (kidney disease). Side effects, drug interactions, dosage, and pregnancy safety should be reviewed prior to taking any medication.
Losartan (Cozaar) is a medication prescribed fro the treatment of high blood pressure. Losartan (Cozaar) belongs to a class of drugs referred to as ARBs (angiotensin receptor blockers). Side effects, drug interactions, warnings and precautions, and pregnancy and breastfeeding safety information should be reviewed prior to taking any medication.
losartan and hydrochlorothiazideLosartan and hydrochlorothiazide (Hyzaar) is a combination drug ( losartan [Cozaar] and hydrochlorothiazide prescribed for the treatment of high blood pressure. Side effects, drug interactions, warnings and precautions, and pregnancy safety information should be reviewed prior to taking any medication.
metoprololMetoprolol (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 fever, impotence, sore throat, nausea, depression, insomnia, constipation, memory loss, and high blood pressure.
Drug interactions, dosing, and pregnancy and breastfeeding safety should be reviewed prior to taking any medication.
telmisartanTelmisartan (Micardis) is in the drug class of angiotensin receptor blockers (ARBs) and is prescribed for the treatment of high blood pressure, reducing the risk of heart attack, stroke, or death from cardiovascular causes (in patients aged 55 years and older). Side effects, dosing information, drug interactions, and warnings and precautions should be reviewed prior to taking any medication.
valsartanValsartan (Diovan) is an ARB drug prescribed for the treatment of high blood pressure and congestive heart failure. Side effects, drug interactions, warnings and precautions, and pregnancy efficacy should be reviewed prior to taking this medication.