ACE inhibitors vs. beta blockers: Which blood pressure medication is right for you?

Seventy-five million American adults have high blood pressure (hypertension), but only 54% of them have their levels under control. Fortunately for a condition as common as high blood pressure, there’s a variety of medications that can help. Among them are ACE inhibitors and beta blockers, which most doctors will prescribe before any other type of medication. 

If you are symptomless, like many people with high blood pressure are, a doctor will probably try an ACE inhibitor first. If your high blood pressure is accompanied by chest pain or anxiety, a beta blocker could be a better option. Doctors may even prescribe both types of medications at the same time under certain circumstances.

What’s the best blood pressure medication for you? Use this guide to compare ACE inhibitors vs. beta blockers to prepare for your next doctor’s visit.

How do ACE inhibitors and beta blockers work?

ACE inhibitors (angiotensin-converting-enzyme inhibitors) dilate blood vessels and decrease blood volume, which lowers blood pressure and increases blood flow to the heart. To do so, ACE inhibitors block the angiotensin-converting enzyme from converting angiotensin I to angiotensin II—a hormone that constricts blood vessels. By blocking the hormone, a person’s blood pressure is lowered.

ACE inhibitors are most commonly prescribed by doctors to treat high blood pressure and heart failure. They can also help reduce the risk of fatalities after a heart attack (myocardial infarction).

Beta blockers (beta-adrenergic blocking agents) block the effects of stress hormones that are part of the sympathetic nervous system. These hormones include norepinephrine and epinephrine (also called adrenaline). Blocking these hormones allows blood vessels to relax and dilate. In turn, beta blockers can slow the heartbeat, lower blood pressure, and improve blood flow.

Beta blockers can treat high blood pressure along with other hmnealth conditions like congestive heart failure, abnormal heart rhythms, anxiety, and chest pain. 

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Can you take ACE inhibitors with beta blockers?

A doctor might prescribe an ACE inhibitor and a beta blocker at the same time to optimize blood pressure levels for high-risk hypertensive patients or people with certain medical conditions like coronary heart disease or chronic heart failure.  

An estimated 75% of patients with high blood pressure will usually require combination therapy (more than one medication) to reach their blood pressure goals, according to the Journal of the American Society of Hypertension. This combination therapy may include taking ACE inhibitors and beta blockers at the same time or taking one with some other type of blood pressure medication like angiotensin receptor blockers (ARBs).

ACE inhibitors and beta blockers work differently and target different parts of the body. In this way, they can complement each other.

Warnings

Both ACE inhibitors and beta blockers can be dangerous for pregnant women. They can cause dizziness from low blood pressure and potentially cause birth defects. If you’re pregnant or may become pregnant, talking with a doctor is the best way to determine whether or not beta blockers or ACE inhibitors are right for you.  

ACE inhibitors raise blood potassium levels, so monitoring potassium intake during treatment is necessary. As a result, taking potassium supplements or using salt substitutes that contain potassium may cause excessive blood potassium levels (hyperkalemia). Hyperkalemia can lead to other, potentially life-threatening health problems. Symptoms of hyperkalemia include confusion, irregular heartbeat, and tingling or numbness in the hands or face.

On the other hand, some beta blockers can increase triglycerides and decrease levels of “good” cholesterol. This is usually temporary but may affect patients with metabolic syndrome.

Drug-drug interactions

ACE inhibitors and beta blockers might not work as efficiently if taken with nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, Advil, and Aleve. Talk with your doctor before taking any NSAIDs while also taking ACE inhibitors, beta blockers, or both.   

Switching from beta blockers to ACE inhibitors

Sometimes, a doctor might change your prescription for a beta blocker to an ACE inhibitor or vice-versa. 

“In situations where patients are having low heart rate or cardiac rhythm abnormalities, either the dose of beta blockers needs to be reduced, or an alternate blood pressure medication like ACEi can be used,” says Atif Zafar, MD, medical director of the University of New Mexico Stroke Program. “In another scenario, where patients have an underlying renal artery disease (like stenosis of renal arteries), ACEi are not recommended for blood pressure control. Other BP medications are better suited for those patients.” 

Some studies suggest that switching from beta blockers to ACE inhibitors can help reduce symptoms of drowsiness and improve cognition. However, this doesn’t necessarily mean that beta blockers are better than ACE inhibitors.

Each drug has its purpose and might be better at treating one particular condition than another. “[ACE inhibitors] are first-line therapy while beta blockers are categorized as second-line therapy for managing BP,” Dr. Zafar says. “However, in patients with coronary artery disease (CAD), or stable ischemic heart disease as comorbid of hypertension, beta blockers and ACEI are recommended first-line choices.” 

Most importantly, talking with a doctor or medical professional is the best way to determine whether or not switching from beta blockers to ACE inhibitors is the right choice for you based on your response to treatment and any side effects you experience. 

Side effects

As with any medication, there is always the potential for side effects. Taking beta blockers, ACE inhibitors, or both may result in some of the following side effects:

This list of side effects is not comprehensive. A medical professional can give you a complete list of side effects associated with ACE inhibitors vs. beta blockers.  

Although it’s rare, ACE inhibitors and beta blockers can be associated with more serious side effects. Taking ACE inhibitors may cause angioedema, a rare condition that causes swelling of the face or other body parts. ACE inhibitors may also cause kidney failure or a decrease in white blood cells.  

Beta blockers have caused severe asthma attacks. For people with diabetes, beta blockers may keep the body from showing signs of low blood sugar (such as tremors and palpitations). Blood pressure levels and heart rate must be monitored while taking beta blockers.

What are the best hypertension medications?

Although there is no one single medication that’s best for treating hypertension, ACE inhibitors and beta blockers are among the most popular types of hypertension drugs. The medication prescribed will depend on the individual’s medical history, symptoms, and response to treatment. A healthcare professional can help determine the best hypertension medication on a case-by-case basis. Here’s a list of some of the most commonly prescribed medications for the treatment of high blood pressure:

Blood pressure medications are selected based on how well they lower blood pressure and reduce the risk of heart attacks, strokes, and heart failure, according to the Journal of the American Society of Hypertension. If an ACE inhibitor or beta blocker won’t work for you, your doctor may recommend another type of antihypertensive drug, such as calcium channel blockers, diuretics, alpha blockers, etc.

Additionally, lifestyle changes can help manage blood pressure along with medications. But above all, a medical professional can help determine the best treatment plan for you based on your symptoms and medical history.