Beta Blocker vs ACE Inhibitor: Which Is Better for High Blood Pressure?

Although lifestyle changes and even some herbal supplements may help lower high blood pressure, medications are commonly prescribed in the later stages of hypertension. 

This article will cover two of the most common blood pressure medications: beta-blocker vs ACE inhibitor.

I’ll explain what each is, how they work, their side effects and drug interactions, and list examples of each.

I’ll also discuss if you can take beta-blockers and ACE inhibitors together, and which is better to take for high blood pressure.

Still, be sure to discuss any medication or possible changes to medications with your healthcare provider.

What Are Beta-Blockers?

Beta-blockers are a class of prescription medications used to manage high blood pressure.

These are also used in the treatment of heart failure, angina (chest pains), and arrhythmia (irregular heartbeat).

Sometimes doctors prescribe beta-blockers to help patients recover from cardiac arrest and prevent future attacks. 

What Are ACE Inhibitors?

ACE inhibitors are a class of prescription medications used to regulate and treat hypertension.

They can be prescribed alone or in tandem with other antihypertensives to manage hypertension, heart failure, and some kidney conditions, and prevent migraine. 

How Do Blood Pressure Medications Work?

Beta-blockers

Beta-blockers work to minimize the workload on the heart by reducing heart rate and blood output, effectively lowering overall blood pressure. 

More specifically, beta-blockers bind to the beta-adrenergic receptors and block chemicals such as adrenaline and noradrenaline from reaching the receptors.

These chemicals stimulate the heart to contract, so beta-blockers lower heart rate and pressure. 

ACE inhibitors

Angiotensin-converting enzyme (ACE) inhibitors limit the production of the chemical angiotensin II through blocking the conversion process from angiotensin I. 

Angiotensin II is a naturally occurring vasoconstricting hormone that narrows arteries and blood vessels in your system.

By reducing the quantity of angiotensin II, ACE inhibitors allow blood vessels to open and expand, lowering overall blood pressure. 

Side Effects

Beta-blockers

Side effects of beta-blockers include:

• Slowed heartbeat
• Reduced circulation to extremities
• Wheezing or difficulty breathing
• Lethargy
• Depression
• Diarrhea 
• Nausea
• Weight gain
• Sexual impotency
• Asthma attacks (rarely)

ACE inhibitors

Side effects of ACE inhibitors include:

• Persistent cough
• Loss of taste
• Skin rashes
• Increased potassium retention
• Dizziness
• Confusion

It’s not recommended to become pregnant while on ACE inhibitors or beta-blockers.

These medications have shown to be dangerous for both baby and parent throughout pregnancy. 

Drug Interactions

Tell your healthcare provider about any current prescription medications, OTC drugs, or supplements you currently take before beginning any new medication.

Beta-blockers

Beta-blockers aren’t as effective when taken in tandem with nonsteroidal anti-inflammatory drugs (NSAIDs).

The long-term combination of NSAIDs and beta-blockers isn’t recommended.

Other medications that may interfere with beta-blocker function include:

• Anesthetics
• Antianginal drugs
• Antiarrhythmics
• Anti-ulcer medications
• HMG-CoA reductase inhibitors
• Inotropic medications
• Other antihypertensive drugs
• Oral hypoglycemics
• Psychotropic drugs
• Rifampicin
• Warfarin

ACE inhibitors

Like beta-blockers, it’s not advised to take NSAIDs in tandem with ACE inhibitors.

Though short-term use shouldn’t lead to symptoms, the long-term combination of NSAIDs with ACE inhibitors may lead to acute renal failure.

Other medications that may interact with ACE inhibitors are antidiabetic drugs, diuretics, and antihypertensive drugs such as ARBs or aliskiren.

Not all interactive substances are medications.

ACE inhibitors boost potassium retention.

Be mindful that taking supplements or eating foods high in potassium may cause harmful effects. 

Examples

Beta-blockers

Some examples of beta-blockers are:

• Acebutolol (Sectral)
• Atenolol (Tenormin, Senormin)
• Betaxolol (Kerlone, Betoptic)
• Bisoprolol (Zebeta)
• Bisoprolol-hydrochlorothiazide (Ziac)
• Metoprolol tartrate (Lopressor)
• Metoprolol succinate (Toprol-XL)
• Nadolol (Corgard)
• Pindolol (Visken)
• Propranolol (Inderal, InnoPran XL, Hemangeol)
• Sotalol (Betapace, Sorine, Sotalol AF)
• Timolol (Timoptic, Betimol)

ACE inhibitors

Some examples of ACE inhibitors are:

• Benazepril (Lotensin)
• Captopril (Capoten)
• Enalapril (Vasotec, Epaned)
• Fosinopril (Monopril)
• Lisinopril (Prinivil, Qbrelis, Zestril)
• Moexipril (Univasc)
• Perindopril (Aceon)
• Quinapril (Accupril tablets)
• Ramipril (Altace)
• Trandolapril (Mavik)

Can You Take Beta-Blockers and ACE Inhibitors Together?

Combining ACE inhibitors and beta-blockers isn’t often recommended as the first line of defense against hypertension.

This is because the combination doesn’t seem to have an advantage over other combination treatments.

However, if you experience stage two hypertension, your doctor may recommend combining medications to treat the condition from multiple angles.

Patients may also receive combination therapy if they suffer from related conditions like heart disease or heart failure. 

Which Is Better for High Blood Pressure? 

Beta-blocker vs ACE inhibitor? Both are comparable in regulating resting blood pressure.

Beta-blockers seem to have a slight advantage when controlling high blood pressure while exercising. 

Talk to your doctor to learn if beta-blockers or ACE inhibitors may interfere with or benefit any pre-existing medical conditions. 

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