Beta blockers are no longer recommended as first line treatment for hypertension (see NICE algorithm, page 3). Prescribing for new patients should follow NICE recommendations. Existing patients who are well controlled can be maintained on beta blockers until review needed.
- Propranolol is included for the management of conditions such as thyrotoxicosis, migraine and anxiety only. Standard formulations should be used first line. For patients where compliance might be a problem, the modified release (M/R) formulation may be considered.
- Labetalol may be used for the treatment of hypertension in pregnancy.
- Sotalol is listed under anti-arrhythmic drugs as the CSM advises that its use should be limited to the treatment of ventricular arrhythmias or prophylaxis of supraventricular arrhythmias.
- Acebutolol maybe useful for the small number of patients with palpitations with slow resting heart rate, as it has intrinsic sympathomimetic activity, but this use is unlicensed. Should be used under specialist supervision only.
For the treatment of acute heart failure, see NICE CG 187 (October 2014)
NICE CG108: Chronic heart failure - Management of chronic heart failure in adults in primary and secondary care (Aug 2010)
This guidance outlines the diagnosis and treatment of chronic heart failure.
Notes on use of beta blockers in heart failure:
- Beta-blockers should be considered for patients in controlled heart failure.
- The NSF states that in people with controlled heart failure beta-blockers started in low doses can reduce mortality when used with other treatments e.g. ACE inhibitors, diuretics and digoxin.
- An appropriate specialist should initiate beta-blockers used in heart failure.
- Nebivolol is only for heart failure patients aged over 70 years. The starting dose is 1.25mg for the first two weeks and then if tolerated 2.5mg for two weeks, then 5mg from then on.