Beta-blockers lower your heart rate and reduce your heart’s workload. If you have heart failure, they may help improve your cardiac function. Possible side effects include unusually slow heart rate and low blood pressure.

Beta-blocker medications block the production of two stress hormones called epinephrine and norepinephrine. Doctors may prescribe these medications to manage various heart-related conditions, such as hypertension (high blood pressure), arrhythmias (abnormal heart rhythms), and heart failure.

A doctor may recommend beta-blockers for heart failure treatment if your heart isn’t pumping blood as effectively as it should. These medications help improve your heart’s efficiency and reduce its workload, so they are also used in other heart-related conditions.

Typical uses of beta-blockers include:

  • Reduced ejection fraction: If you have reduced ejection fraction (also known as chronic heart failure), your heart’s lower left chamber is not pumping blood adequately. By enhancing your heart’s pumping ability, beta-blockers can improve survival rates and reduce the frequency of hospitalizations.
  • Abnormal heart rhythm: Beta-blockers may be effective for managing some types of abnormal heart rhythms, particularly tachycardia (more than 100 heartbeats per minute), which may be a symptom and a risk factor for heart failure.
  • History of heart attacks: A doctor may recommend ongoing treatment with beta-blockers to reduce the risk of future heart attacks.
  • High blood pressure: By lowering the force of blood flow against your arteries, beta-blockers may decrease the overall strain on your heart and help it function effectively. High blood pressure may lead to heart failure, and beta-blockers may help reduce this risk.
  • Angina (chest pain): Beta-blockers may relieve chest pain related to heart disease by improving blood flow and regulating your heart rate.
  • Combination therapy: Beta-blockers can be used in combination with other medications to manage chronic heart failure, especially if you experience frequent episodes of severe symptoms.

While beta-blockers can be helpful in treating heart failure symptoms and causes, they may not be the go-to treatment in some situations, such as:

  • Severe bradycardia (abnormally slow heart rate): Beta-blockers can worsen a slow heart rate, potentially leading to severe complications such as fainting or heart failure.
  • Asthma or severe chronic obstructive pulmonary disease (COPD): Beta-blockers may cause bronchospasm, which can worsen breathing difficulties in people with these conditions.
  • Severe hypotension (low blood pressure): Beta-blockers may worsen low blood pressure, leading to inadequate blood flow to your vital organs.
  • Severe peripheral artery disease: Beta-blockers may reduce blood flow to your extremities, leading to worsening symptoms of severe or advanced peripheral artery disease.

A doctor may want to assess your medical history, co-occurring conditions, and current symptoms before determining whether you need to avoid beta-blockers. Only a healthcare professional can decide when and if you need to discontinue beta-blocker treatment.

Discontinuing beta-blockers

You should not stop taking beta-blockers abruptly or without the supervision of a medical professional. Discontinuing beta-blocker use without a tapering plan may increase your chance of having a heart attack if you’ve already had one. It can also increase the risk of other complications, such as high blood pressure and chest pain.

A doctor may evaluate your individual needs before recommending a specific brand or type of beta-blocker. They may also decide to use another medication or a different beta-blocker.

A healthcare professional may consider beta-blockers for treating heart failure if the percentage of blood that leaves your heart with each heartbeat is 40% or less.

The following sections discuss a few beta-blocker options for heart failure.

Carvedilol

Carvedilol (Coreg) works by blocking beta and alpha-1 receptors. As a result, it helps reduce heart rate and blood pressure, decreasing your heart’s workload. This medication comes as an oral tablet.

  • Who should not use it: people with severely slow heart rate, unmanaged asthma, or severe liver problems

Metoprolol succinate

Metoprolol succinate (Toprol-XL) selectively blocks beta-1 receptors, helping reduce heart rate and blood pressure and improving heart function and symptoms of heart failure.

This medication is available as an extended-release oral tablet or capsule.

  • Who should not use it: people with severely slow heart rate, severe low blood pressure, or second or third degree heart block

Bisoprolol

Bisoprolol selectively blocks beta-1 receptors, resulting in a slower heart rate and lower blood pressure and reducing your heart’s oxygen demand. You may take it as an oral tablet or receive it intravenously.

  • Who should not use it: people with severely slow heart rate, severe COPD, or asthma

The use of any of these beta-blockers or any other medication for heart failure depends on many factors. You can discuss your options with the healthcare professional who is prescribing the medication.

The possible side effects of beta-blockers can vary from person to person but may include:

Some drugs may also mask symptoms of low blood sugar in people with diabetes and may trigger or worsen symptoms of depression.

A doctor will select the most appropriate beta-blocker for heart failure treatment based on your symptoms and overall health.

A doctor may recommend other treatments for heart failure in addition to beta-blockers. These treatments aim to improve heart function, manage symptoms, and enhance quality of life.

Options may include:

  • Medications: A doctor may also prescribe:
    • ACE inhibitors: These medications relax blood vessels and reduce your heart’s workload. Examples include enalapril (Vasotec) and lisinopril (Zestril).
    • Angiotensin II receptor blockers: These medications relax your blood vessels and lower your blood pressure. Losartan (Cozaar) and valsartan (Diovan) are common examples.
    • Diuretics and aldosterone antagonists: These drugs help manage fluid retention. Examples include furosemide (Lasix) and spironolactone (Aldactone).
  • Lifestyle changes: If applicable, strategies such as opting for a low sodium diet, engaging in regular exercise, quitting smoking, and limiting alcohol intake can help improve heart failure.
  • Implantable devices: A device such as a pacemaker or an implantable cardioverter-defibrillator can regulate your heart rhythm and prevent sudden cardiac-related death.
  • Surgery: In severe cases, a doctor may suggest surgical procedures such as coronary bypass surgery, heart valve replacement or repair, or a heart transplant.

A doctor may prescribe beta-blockers to manage heart failure if the amount of blood that leaves your heart with each heartbeat is significantly less than what’s expected. Beta-blockers may improve symptoms and outlook by lowering your blood pressure and heart rate, thus easing your heart’s workload.

Beta-blockers may not work for all cases of heart failure, and they come with potential risks, including unusually slow heart rate, fatigue, and low blood pressure. A healthcare professional will evaluate your individual needs before starting or stopping a treatment plan.