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Why a beta blocker vs. an ACE inhibitor?
Physicians have many choices of medications to treat high blood pressure. Beta-blockers and diuretics have been demonstrated to reduce the risk of complications associated with long standing hypertension (high blood pressure) more than other classes of drugs. Furthermore, the side effects are generally minimal when used in ideal patient candidates. (Beta blockers might not be tolerated by persons with asthma, congestive heart failure, depression, or underlying fatigue.) Beta blocker drugs, such as propranolol, can be especially helpful in patients with high blood pressure that is associated with coronary artery disease or abnormal heart rhythms (such as tachycardia). However, in patients with certain co-existing conditions, other classes of medications may be preferred.
ACE inhibitors, for example, have protective effects for the kidney in persons with diabetes or in persons with early kidney damage. In persons with congestive heart failure, ACE inhibitors may prolong survival. There is some evidence that persons with a condition called left ventricular hypertrophy (LVH), ACE inhibitors may be more effective than other classes of medications. LVH is a condition in which the largest muscular part of the heart has expanded, a direct result of the strain of having to beat against a high pressure. LVH is associated with an increased risk of heart disease. Also, ACE inhibitors are the blood pressure medication of choice in persons with scleroderma, a disease which can be associated with severe blood pressure elevation and kidney failure.