How much will beta blockers lower my blood pressure?

Although beta blockers are not recommended as a first-line therapy for adults with hypertension according to the 2017 American College of Cardiology and American Heart Association hypertension guidelines,¹ studies on hypertensive patients show that beta blocker treatments can be effective in reducing blood pressure. A drug class review compared the use of various beta blockers in hypertensive patients and found that there were no significant differences among beta blockers in lowering blood pressure.²

Metoprolol and Atenolol (Beta-1-selective)

When metoprolol controlled-release (CR) treatment was compared to atenolol treatment in, there were no significant differences in blood pressure reduction. After six weeks of treatment in 60 patients with mild to moderate hypertension, both metoprolol and atenolol reduced systolic and diastolic blood pressure significantly when measured 24 hours after drug administration. There were no significant differences in blood pressure reduction between metoprolol CR (95% confidence interval [CI] [-4 – 3 mm Hg] and atenolol (95% [CI] [-1 – 4 mm Hg]).³ Another study that compared metoprolol CR and atenolol in 74 hypertensive patients also found that both metoprolol CR and atenolol were effective in reducing systolic and diastolic blood pressures from an average of 159/98 mm Hg to 144/87 mm Hg versus 144/88 mm Hg, respectively.⁴

When atenolol was compared to other beta blockers (e.g., epanolol, pindolol, and bisoprolol), atenolol was found to be more effective in reducing blood pressure,^5-7 with the exception of bisoprolol.⁸ In a study comparing epanolol to atenolol in 12 patients, atenolol was more effective in reducing blood pressure.⁵ Systolic and diastolic pressures fell from 168/107 mm Hg at baseline to a 24-hour ambulatory blood pressure of 128/91 mm Hg on atenolol and of 137/97 mm Hg on epanolol (p<0.01). When atenolol was compared to pindolol, atenolol reduced diastolic blood pressure significantly more than pindolol did (p<0.02 – p<0.01 difference). After two weeks of treatment, blood pressure fell from 155 ± 7/106 ± 6 mm Hg to 127/84 mm Hg on atenolol and from 158 ± 12/107 ± 8 mm Hg to 129/89 mm Hg on pindolol (p<0.001). In a study of 292 hypertensive patients, atenolol and bisoprolol treatments were compared. In the atenolol 50 mg, bisoprolol 5 mg, and bisoprolol 10 mg groups supine blood pressures were 160.0/102.2 mm Hg, 163.9/102.5, and 157.4/101.8, respectively.⁷ After 26 weeks of treatment, supine blood pressures were measured to be 148.6/91.7 mm Hg, 150.6/90.8, and 142.0/89.1, respectively. There were no significant differences between the atenolol and bisoprolol group. In a different study comparing atenolol and bisoprolol treatment, blood pressure was reduced significantly more in the bisoprolol group.⁸ After eight weeks of treatment, 56% on atenolol and 68% of patients on bisoprolol achieved diastolic blood pressure of ≤95 mm Hg (p≤0.05).

Carvedilol and Nebivolol (Vasodilating)

A meta-analysis of carvedilol use in 36 clinical studies of 3,412 patients with mild-to-moderate essential hypertension concluded that carvedilol is effective in reducing blood pressure.⁹ The review found that two to four weeks of daily administration of 25 mg or 50 mg doses of carvedilol significantly decreased mean systolic and diastolic blood pressure.⁹ For the group that received 25 mg, carvedilol reduced systolic and diastolic blood pressures by 15.5 mm Hg and 11.2 mm Hg, respectively, from a baseline value of 165.6/102.7 mm Hg (p<0.001). The group that received 50 mg experienced 17.9 mm Hg and 13.0 mm Hg reduction from a baseline systolic/diastolic value of 166.5/104.8 mm Hg (p<0.001). Many clinical trials have also shown that carvedilol treatment is effective in lowering systolic and diastolic blood pressure in patients with hypertension.^10-13 When nebivolol treatment was studied in 811 patients with stage I and stage II hypertension, only the 20 mg dose produced a significant reduction when compared to the placebo (p<0.001).¹⁴ Nebivolol treatment of 5 mg, 10 mg, or 20 mg reduced mean trough sitting diastolic blood pressure by 7.8 mm Hg, 8.5 mm Hg, and 9.1 mm Hg, respectively, compared to 4.6 mm Hg for the placebo. When nebivolol was compared to metoprolol in hypertensive men, both treatments reduced blood pressure to a similar extent.¹⁵ Baseline systolic and diastolic blood pressures for both groups were 149.4 ± 4.3/92.9 ± 1.9 mm Hg and 148.2 ± 4.8/93.0 ± 1.8 mm Hg, respectively. After treatment, all patients reached the target systolic blood pressure of <140 mm Hg and diastolic blood pressure of <90 mm Hg.

^References

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14. Greathouse M. Nebivolol efficacy and safety in patients with stage I-II hypertension. Clin Cardiol. 2010;33(4):E20-27.
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