Beta-Blockers: Why You Need Them for Heart Failure

Beta-blockers are some of the most effective medications for treating chronic heart failure. Chances are, your doctor has prescribed a beta-blocker for you if you’ve had a heart attack or have:

• Systolic heart failure (when your heart does not contract strongly enough).
• High blood pressure.
• Tachycardia (fast heart rate).
• Arrhythmia (irregular heartbeat).

Beta-blockers are drugs that can slow your heart rate and keep it from overworking. They also can stop your heart from responding to stress hormones, such as adrenaline. Over time, beta-blockers may help your heart pump better.

“Beta-blockers remain one of the most important drugs we prescribe, because in the long term they help patients live longer,” says cardiologist W.H. Wilson Tang, MD.

Your doctor might prescribe other medicines along with beta blockers to improve your heart failure symptoms, such as:

• Aldosterone antagonists: These medicines block hormones that make your heart failure worse. They cause your kidneys to make more urine, which flushes excess salt and water out of your body and makes it easier for your heart to pump.
• Angiotensin receptor-neprilysin inhibitors (ARNI): These combination medicines help your heart pump blood better so that you can have fewer symptoms as you carry out your everyday activities.
• Sodium-glucose cotransporter 2 inhibitors (SGL2T-i): This newer class of drugs may help your heart work better. If you have diabetes, they will also help lower your blood sugar.

These drugs are pillars of heart failure treatment and lower your risk of a cardiovascular event.

Beta blockers: use as directed

When you start taking beta-blockers, your symptoms may become slightly worse for about two to three weeks as your heart adjusts to them. You might feel more tired or dizzy. That’s normal. However, you’ll need to check your blood pressure and heart rate to make sure they don’t drop too low.

It’s critical to take beta-blockers as directed. Even if you think they aren’t working or aren’t making you feel better, they’re helping prevent your heart disease from getting worse.

It’s especially important to continue beta-blockers if you’ve been taking them long-term. Studies show that abruptly stopping them can cause chest pain and increase your risk of sudden cardiac death.

So, don’t stop taking your beta-blockers unless you discuss it with your physician – even if they’re causing side effects such as:

• Dizziness or lightheadedness.
• Tiredness.
• Cold hands and feet.
• Headache.
• Nightmares or difficulty sleeping.
• Nausea, vomiting, heartburn, diarrhea, constipation or gas.
• Sudden weight gain (such as gaining three or more pounds in one day, or gaining weight for more than two days).
• Difficulty breathing, increased shortness of breath or wheezing.
• Skin rash.
• Slow, fast or irregular heartbeat.
• Swelling of feet and lower legs.
• Chest pain — but contact your doctor or nurse right away.

If any of these side effects are severe or don’t go away, talk to your doctor about how to control them. Sometimes your doctor can:

• Lower your beta-blocker dosage.
• Adjust your other medications.
• Recommend alternate ways to take your beta-blocker so it doesn’t interact with other medications.

The No. 1 reason people (wrongly) stop taking beta-blockers

“The top reason patients stop using beta-blockers is admission to the hospital – for various conditions, not just heart failure,” Dr. Tang says. “However, most people should not stop, even if they are hospitalized, unless the doctors decided that it is more harm than good.”

Research shows that patients fare better when they continue taking beta-blockers while in the hospital, even with acute heart failure.

“An inability to tolerate beta-blockers indicates a worsening heart condition,” says Dr. Tang. “Other testing may be necessary to determine if the heart is too weak for beta-blockers.”

This may even apply for patients whose heart function has recovered to the normal range. “Recent clinical studies have shown that, even in those with full recovery of their heart structure and function, stopping drugs like beta-blockers can reverse the recovery course and can be detrimental,” he adds.

Resuming beta-blockers isn’t so easy

If you stopped taking beta-blockers, re-determining the correct dosage is a complicated process. While it’s important that you resume beta-blockers, you will need to closely follow instructions from your doctor. Doctors have learned to start low and go slow in increasing the dose so that your body can readjust to the drug.

In general, doctors have learn to start low and go slow in increasing the dose so that you body can readjust to the drug.

“How much and how quickly to increase the dose will depend on your medical condition,” says Dr. Tang. “It can take time and even adjustment of other medications in order to maintain adequate blood pressure.”

Your best precaution? Make sure you always have enough beta-blocker medication on hand. Running out – or simply not taking your medication – can be dangerous.