“Beta Blockers” are medications which are traditionally prescribed by cardiologists and primary care clinicians for patients who have had heart failure or heart attacks or abnormal heart rhythms. “Beta Blockers” are sometimes used for patients with hypertension. Beta blocker medications usually end in “olol” like “atenolol” or “metoprolol” or “carvedilol”. Brand names include “Tenormin” and “Toprol XL” and “Coreg” and “Bystolic”. Sometimes the medication “propranolol” or “Inderal” is used to prevent migraines or treat essential tremor.
For many years, we have advised patients taking beta blockers that although these medications are associated with weight gain, they should not just stop the beta blocker abruptly because it may be a life-saving medication. Previous studies showed that patients who took beta blockers for reasons like heart failure and heart attacks had longer and healthier lives if they took those beta blockers. For patients who were taking the beta blocker for another reason like hypertension or migraine prevention, Dr. Marlowe would work with them to change the medication to one that was not associated with weight gain. When a patient was taking the beta-blocker for their heart, Dr. Marlowe would gently suggest the patient discuss with their cardiologist if another medication might suffice, especially if the reason for taking the medication was abnormal heart rhythms.
However, a recent study in the Journal of American Medical Association provides evidence that perhaps the recommendations to wean off the beta blockers should have been stronger. The most recent study evaluated 44,708 patients and researchers found evidence that for many patients, the beta blockers were not helpful, and for some patients the beta blockers were downright harmful. In patients who had a diagnosis of coronary artery disease or who had a heart attack more than one year ago, there was no statistically significant difference between the patients who took beta blockers and those who did not, as far as risk of stroke, heart attack, or cardiovascular death. In patients who had never had a heart attack but only had a diagnosis of coronary artery disease, the patients who were on beta blockers had a higher risk of hospitalization. Most importantly, in the patients who never had a heart attack and did not have coronary artery disease but merely had risk factors for heart disease … those patients taking beta blockers had a higher risk of stroke, heart attack, and/or cardiovascular death.
Now, Dr. Marlowe has always strongly advised patients not to stop their beta blockers on their own without the guidance of a physician. If you are reading this article and think it is a good idea to immediately stop your beta blocker medication, you are terribly wrong. Don’t do it. Many patients who simply stop a beta blocker have “rebound” hypertension and can have dangerously high blood pressures.
For patients who have had a heart attack, within the year that they have had the heart attack, those taking the beta blockers did have statistically significantly improved outcomes. So, the medications are still a valuable consideration. We suspect that many discussions with patients and cardiologists will result in the conclusion that the benefits of the beta blockers outweigh the risks. However, there will be many cases where the risks of stroke, heart attack, and death will need to be weighed against the benefits of the medication and the decision will be made to discontinue the beta blocker.
Dr. Marlowe has for many years successfully helped patients transition off their beta blockers to other medications and will continue to help patients weigh their risks and benefits in making the best decision.