Beta-Blockers for Heart Failure
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How It Works
Beta-blockers are a class of drugs used to control symptoms of heart failure that are made worse by certain hormones called catecholamines. The body releases these hormones as part of its response to heart failure. For this and other reasons, beta-blockers have been shown to be effective for treating most people who have heart failure.
Beta-blockers have a variety of effects throughout the body. They are used to treat heart disease that causes chest pain, high blood pressure, heart attacks, and cardiomyopathy and irregular, rapid heartbeats (arrhythmia). Beta-blockers are also used to prevent migraine headaches, treat tremors, and control anxiety.
- Beta-blockers may work by slowing the heart rate, which allows the left ventricle (the main pumping chamber of the heart) to fill more completely.
- Some of these medicines may also help open or widen blood vessels in the body. This makes them especially useful in some people with certain forms of heart failure who may also have high blood pressure.
Bisoprolol, carvedilol, and metoprolol are some of the beta-blockers that have been tested for use in the treatment of heart failure.
Why It Is Used
Beta-blockers can slow the progression of systolic forms of heart failure. Beta-blockers may be used to treat left ventricular systolic dysfunction in people who are stable and have no symptoms or only mild to moderate heart failure symptoms. Beta-blockers may be used together with other medicines that are usually used to treat heart failure, such as angiotensin-converting enzyme (ACE) inhibitors or diuretics.
Beta-blockers may be used to treat diastolic heart failure too. With diastolic heart failure, the heart does not have enough time to relax and fill with blood before pumping it out to the rest of your body. Beta-blockers help treat diastolic heart failure, because they slow the heart rate and allow more time for your heart to fill with blood. This allows the left ventricle to fill more completely and increases the volume of blood that the heart pumps with each heartbeat (ejection fraction). Then, your heart can pump more blood with each heartbeat.
How Well It Works
Certain beta-blockers have been shown to:1
- Improve the percentage of blood pumped from the left ventricle with each heartbeat (ejection fraction).
- Reduce the need for hospital stays.
- Slow the progression of heart failure.
- Reduce the risk of death caused by heart attack and heart failure.
Beta-blockers are one of four medicines recommended for use in most people who have systolic heart failure. Others include diuretics, ACE inhibitors, and sometimes digoxin.
All medicines have side effects. But many people don't feel the side effects, or they are able to deal with them. Ask your pharmacist about the side effects of each medicine you take. Side effects are also listed in the information that comes with your medicine.
Here are some important things to think about:
- Usually the benefits of the medicine are more important than any minor side effects.
- Side effects may go away after you take the medicine for a while.
- If side effects still bother you and you wonder if you should keep taking the medicine, call your doctor. He or she may be able to lower your dose or change your medicine. Do not suddenly quit taking your medicine unless your doctor tells you to.
Call 911 or other emergency services right away if you have:
- Trouble breathing.
- Swelling of your face, lips, tongue, or throat.
- Fainting or severe dizziness.
Call your doctor right away if you have:
- A very slow heart rate (less than 50 beats per minute).
- Swelling in your legs or feet.
- Shortness of breath or wheezing, especially if you have asthma.
- Cold hands and feet.
Common side effects of this medicine include:
- Dizziness or lightheadedness.
- Feeling tired.
- Trouble sleeping.
See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)
What To Think About
Check your pulse. Your doctor may ask you to take your pulse regularly to make sure your heart rate is not too slow. To learn how to take your pulse, see the topic Taking a Pulse (Heart Rate).
Diabetes. If you have diabetes, beta-blockers may cause higher blood sugar levels. Watch closely for symptoms of low blood sugar, because beta-blockers can hide your symptoms.
Grapefruit juice. Grapefruit juice may affect how beta-blockers work. Ask your doctor if you need to make any changes to avoid problems. For more information, see Grapefruit Juice and Medicines.
Cold weather. Beta-blockers may make you more sensitive to cold weather. Dress warmly and if needed, limit your time in cold weather.
Sun exposure. Beta-blockers may make you more sensitive to sunlight. You might get sunburnt easily or get a rash. To prevent problems, try wearing sun block, long sleeved shirts, and hats.
Allergic reactions. If you have food, medicine, or insect-sting allergies, beta-blockers may cause allergic reactions to be worse and harder to treat. If you have a severe allergic reaction, tell your doctor that you are taking a beta-blocker.
Medicine is one of the many tools your doctor has to treat a health problem. Taking medicine as your doctor suggests will improve your health and may prevent future problems. If you don't take your medicines properly, you may be putting your health (and perhaps your life) at risk.
There are many reasons why people have trouble taking their medicine. But in most cases, there is something you can do. For suggestions on how to work around common problems, see the topic Taking Medicines as Prescribed.
For tips on taking medicine for heart failure, see:
Advice for women
If you are pregnant, breast-feeding, or planning to get pregnant, do not use any medicines unless your doctor tells you to. Some medicines can harm your baby. This includes prescription and over-the-counter medicines, vitamins, herbs, and supplements. And make sure that all your doctors know that you are pregnant, breast-feeding, or planning to get pregnant.
Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.
- Hunt SA, et al. (2009). 2009 focused update incorporated into the ACC/AHA 2005 guidelines for the diagnosis and management of heart failure in adults. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation, 119(14): e391–e479.
Last Revised: April 26, 2012
Author: Healthwise Staff
Medical Review: Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology & Margaret Hetherington, PHM, BsC - Pharmacy
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