Beta blockers to reduce blood pressure

Beta blockers are not recommended as first-line therapy for patients with uncomplicated elevated blood pressure (BP) because they are less effective than the first-line drugs in reducing the risk of stroke. However, they are useful in patients with both elevated BP and stable angina (see Stable angina), and after myocardial infarction (see Long-term management of acute coronary syndromes). Heart failure with reduced ejection fraction (HFrEF) should be treated with specific beta blockers (see Beta blockers for HFrEF).

If a beta blocker is considered appropriate to reduce BP, start with a low dose and increase slowly as required. Suitable dose ranges are:

Stopping a beta blocker suddenly may lead to rebound sympathetic effects (eg high BP, tachyarrhythmia). If stopping a beta blocker, halve the dose every 2 to 3 days until the dose of atenolol is 25 mg daily, or the dose of metoprolol is 25 mg twice daily, then stop. Withdrawal effects can generally be managed by restarting the drug.