Beta-blockers should not be used as 1st-line therapy for uncomplicated hypertension in patients >60 years (Canada) unless there are comorbid conditions that benefit from beta-blockers. (Beta-blockers are highly effective agents in patients with other indications (such as post-myocardial infarction for a time-limited period, or heart failure with reduced ejection fraction).
Beta-blockers may increase hypotension (HoTN). Symptoms of HoTN include blurred vision, dizziness or lightheadedness, falls, fatigue, and nausea.
Avoid antihypertensives in patients with late-stage dementia.
Taper Approach: Reduce the dose by 50% every 1 to 2 weeks Once you get to 25% of the original dose and no withdrawal symptoms have been seen, stop the drug If any withdrawal symptoms occur, go back to approximately 75% of the previously tolerated dose.
Monitor – diuretics drugs: weight gain, swelling, shortness of breath.
Monitor – blood pressure drugs: chest pain, pounding heart, heart rate, blood pressure (re-measure for up to 6 months), anxiety, tremor.
- A guide to deprescribing antihypertensive agents [Primary Health Tasmania (Tasmania PHN)]
- Antihypertensive Medications and Serious Fall Injuries in a Nationally Representative Sample of Older Adults (JAMA Internal Medicine).
- Blood pressure pills ‘raise risk of fatal fall’ (The Telegraph).
- Exploring the enablers and barriers to implementing the Medication Appropriateness Tool for Comorbid Health conditions during Dementia (MATCH-D) criteria in Australia: a qualitative study. BMJ Open
- Atenolol & Beta-Blockers for Primary Hypertension: Do They Perform Under Pressure? – Alberta College of Family Physicians (ACFP)
- Beta Blocker Use After Acute Myocardial Infarction in the Patient with Normal Systolic Function: When is it “Ok” to Discontinue? – Current Cardiology Reviews, 2012, 8, 77-84
- How Long Should We Continue Beta-Blockers After MI? – American College of Cardiology