Beta-Blockers for Heart Failure: Everything You Need to Know

By Robynn Lowe
Medically reviewed checkmarkMedically reviewed
July 14, 2022

More than 6 million U.S. adults experience heart failure. 

Congestive heart failure is a cardiovascular disease that develops when your heart is unable to pump enough blood to your organs.

Although heart failure requires immediate attention, your heart is still functioning. 

Untreated heart failure can damage the liver and kidneys. 

It can also lead to other cardiac conditions such as hypertension, arrhythmia (irregular heartbeat), and cardiac arrest. 

In this article I’ll first explain what beta-blockers are, how they work, and what they’re used for. 

Then I’ll cover the FDA-approved beta-blockers for heart failure and their side effects. 

I’ll wrap up with when to see a medical provider about beta-blockers for heart failure.

What Are Beta-Blockers?

Beta-blockers are a class of prescription medications that reduce the heart’s workload.

They’re commonly prescribed to patients with high blood pressure and other cardiovascular diseases, such as congestive heart failure.

Beta-blockers are usually taken as oral medication but are also available as intravenous and ophthalmic treatments. 

There are different types of beta-blockers. 

Because these medications can interact with chemical receptors in the body, it’s important to know which beta-blocker is best for your health. 

How Do Beta-Blockers Work?

Beta-blockers work through binding themselves to the beta-adrenergic receptors

These receptors normally respond to natural chemicals like adrenaline and noradrenaline, which stimulate the heart’s contractions. 

When these receptors are blocked, your heart rate and blood pressure decrease. 

The three types of beta-receptors are:

  • Beta-1 (B1) receptors, found in the heart
  • Beta-2 (B2) receptors, found throughout the body
  • Beta-3 (B3) receptors, found in adipose tissue and smooth muscle cells

For congestive heart failure, beta-blocker therapy targets beta-1 receptors in the cardiac system.

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Uses of Beta-Blockers

Beta-blocker therapy is commonly used to reduce heart rate, high blood pressure, chest pains (angina), arrhythmia, and heart failure. 

Beta-blockers can help treat early stages of congestive heart failure and are effective in helping patients recover from cardiac arrest.

Less frequently, beta-blocker treatment is used to prevent migraines or regulate hyperthyroidism

A doctor may even prescribe beta-blockers to lower heart rate in people diagnosed with anxiety

FDA-Approved Beta-Blockers for Heart Failure

Though there are many different beta-blocker medications, only three are approved by the FDA for treating congestive heart failure.

Bisoprolol (Zebeta)

Bisoprolol is a cardioselective blocker, meaning it targets the beta-1 receptors in the heart without blocking beta-2 receptors.

One study looked at beta-blocker therapy for individuals with coexisting heart failure and chronic obstructive pulmonary disease (COPD). 

The results demonstrated a slight survival benefit for bisoprolol compared to carvedilol and metoprolol. 

Carvedilol (Coreg)

Carvedilol is a non-selective beta blocker with included alpha-1 adrenergic receptor-blocking properties. 

Carvedilol treats mild to severe heart failure. 

One study found that carvedilol improves symptoms while reducing progression of heart failure

Carvedilol also reduced the rate of death by up to 35%. 

Metoprolol (Toprol)

Metoprolol targets beta-1 receptors with minimal effect on beta-2 receptors. 

In a comparative study of carvedilol and metoprolol treatment, people taking metoprolol had a higher all-cause mortality rate.

The two medications had comparable side effects. 

Side Effects

Most common

Some of the most common side effects of beta-blockers include:

  • Dizziness or fatigue
  • Poor circulation to extremities
  • Diarrhea
  • Nausea
  • Insomnia and nightmares
  • Wheezing or difficulty breathing
  • Lethargy or depression
  • Weight gain
  • Sexual impotency

Less common

Talk to a medical professional immediately if you experience:

  • Swelling of the extremities and chest pain or irregular heartbeat
  • Shortness of breath, wheezing, and chest pain
  • Asthma attacks
  • Jaundice (yellowing of the skin or eyes)

Beta-blockers have been associated with a higher hospitalization risk in people who have stiff heart congestive heart failure. 

“Stiff heart” describes the condition of a heart that has difficulty relaxing after constriction. 

Interactions and Cautions

While beta-blockers can be used for any stage of congestive heart failure, they aren’t the first line of defense. 

Using beta-blockers is recommended after you’ve received therapy via diuretics and ACE inhibitors

It can be dangerous to increase medication doses too quickly, so doctors typically begin patients on a low dose and slowly increase the dose.

Beta-blockers can interact adversely with medications that treat: 

Because beta receptors are located throughout the body, it’s important to talk to your doctor about all pre-existing health conditions as well as lifestyle habits that may cause interactions.

Tell your doctor if:

  • You’re looking to become pregnant or think you may be pregnant
  • You smoke
  • You experience asthma or lung disease
  • You have a slow heart rate or low blood pressure
  • You experience circulation issues
  • You’ve had allergic reactions to beta blockers or past medications
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When to See a Healthcare Provider 

If you have trouble breathing, experience chest pains, or see sudden swelling of the hands and feet, contact a medical professional immediately. 

Asthma attacks and jaundicing also require medical attention. 

If you’re having an allergic reaction to beta-blockers or become pregnant while taking beta-blockers, contact your doctor.

Beta-blockers reduce the heart rate

A slow heart rate can be a concern if it falls below 60 beats per minute, indicating bradycardia

When the heart beats too slowly for a prolonged time, reduced blood flow to the brain may cause more serious side effects.

How K Health Can Help

Did you know you can get affordable primary care with the K Health app?

Download K to check your symptoms, explore conditions and treatments, and if needed text with a doctor in minutes.

K Health’s AI-powered app is HIPAA compliant and based on 20 years of clinical data.

Frequently Asked Questions

Which beta-blocker is best for patients with heart failure?
Bisoprolol has shown to have a slight advantage in treating people with coexisting heart failure and chronic obstructive pulmonary disease (COPD). Carvedilol may cause fewer side effects and has fewer contraindications for people who have heart failure without coexisting conditions.
Are beta-blockers good for heart failure?
Beta-blocker therapy for congestive heart failure can be a treatment option when ACE inhibitors or diuretics aren’t an option or don’t help. Beta-blockers can treat and prevent the procession of heart failure.
Do beta-blockers weaken the heart?
Beta-blockers don’t weaken the heart. They reduce the strain and workload on the heart. Using beta-blockers correctly should strengthen the heart over time.
K Health articles are all written and reviewed by MDs, PhDs, NPs, or PharmDs and are for informational purposes only. This information does not constitute and should not be relied on for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

Robynn Lowe

Robynn Lowe is a board certified Family Nurse Practitioner with over 15 years in the medical field. Robynn received her Bachelor's and Master's degrees from Florida Atlantic University and has been practicing in rural family medicine since. Robynn is married to her college sweetheart, Raymond and they have three awesome children. When Robynn isn't with patients you can find her shopping, coaching her kids sports teams, or spending time on the water.