ACE Inhibitors vs Beta-Blockers: Which Medication Is Best Suited For You?

Hypertension affects about 1 in 2 Americans across the nation. ACE inhibitors and beta-blockers are both commonly used to treat hypertension, but they work in different ways and are prescribed based on specific patient needs.

ACE Inhibitors

ACE inhibitors are used to widen your blood vessels and reduce blood volume, which results in decreased blood pressure and enhances blood flow to your heart. But how do they do that?

ACE inhibitors (Angiotensin-Converting Enzyme inhibitors) work by blocking the enzyme that converts angiotensin I to angiotensin II, a substance that narrows blood vessels and raises blood pressure. By preventing this conversion, ACE inhibitors help relax blood vessels, which lowers blood pressure and reduces the workload on the heart. They are often prescribed for patients with hypertension, heart failure, and those with diabetes or chronic kidney disease because of their protective effects on the kidneys.

Additionally, ACE inhibitors prevent the breakdown of bradykinin by the enzyme ACE. Bradykinin is a protein that helps your kidneys remove sodium from your body and therefore, reduces your blood pressure by relaxing your blood vessels. When there is less bradykinin present, your blood pressure rises.

ACE inhibitors typically end in “-pril". Common examples include:

• Benazepril (Lotensin)
• Captopril
• Enalapril (Vasotec)
• Fosinopril
• Lisinopril (Prinivil, Zestril)
• Moexipril
• Perindopril
• Quinapril (Accupril)
• Ramipril (Altace)
• Trandolapril

Beta-Blockers

Beta-blockers work by blocking the effects of adrenaline (epinephrine) on beta receptors in the heart. This action reduces the heart rate and the force of heart contractions, which lowers blood pressure and decreases the heart’s oxygen demand. Beta-blockers are often prescribed for patients with hypertension, especially if they have other heart-related conditions such as angina (chest pain), heart failure, or have had a heart attack. They are also used to manage arrhythmias (irregular heartbeats).

Beta receptors

• Beta-1 (β1)-adrenergic receptors: Located in your eyes, heart, and kidneys
• Beta-2 (β2)-adrenergic receptors: Mainly located in your gastrointestinal tract (GIT), uterus, lungs, liver, blood vessels, and skeletal muscle
• Beta-3 (β3)- adrenergic receptors: Located in fat cells

Beta-blockers decrease your blood pressure by competitively blocking beta-1 and/or beta-2 adrenergic receptors, resulting in decreases in heart rate and cardiac muscle contractility.

Beta-blockers typically end in “-olol". Common examples include:

• Beta-1 selective blockers: Atenolol (Tenormin), Acebutolol, Betaxolol, Bisoprolol, Metoprolol tartrate (Lopressor), Metoprolol succinate extended-release (Toprol XL)
• Beta-1 selective blocker with nitric oxide-dependent vasodilation: Nebivolol (Bystolic)
• Non-selective beta-1 and beta-2 blockers: Nadolol (Corgard), Nadolol (Corgard), Propranolol (Inderal LA, Inderal XL)—May be used for migraines and essential tremors, Timolol—Used to treat glaucoma or ocular hypertension
• Non-selective beta-blocker and alpha-1 blockers: Carvedilol (Coreg, Coreg CR), Labetalol—Considered the drug of choice in pregnancy

Similarities

Both ACE inhibitors and beta-blockers are effective in managing hypertension and cardiovascular issues. Studies have shown that these medications are equally efficient in lowering blood pressure and helping with cardiovascular problems in individuals with hypertension.

However, research indicates that thiazide diuretics and calcium channel blockers are more effective as first-line treatments for Black individuals. This is due to evidence suggesting that these drug classes provide better blood pressure control and cardiovascular outcomes in this population compared to ACE inhibitors and beta-blockers.

Differences

Although both drug classes have comparable physiological effects, a medical professional can assist you in determining if ACE inhibitors, beta-blockers, or both are best for you.

Indications

Besides treating high blood pressure, these drug classes are also used for the following conditions:

ACE Inhibitors

• Heart failure
• Coronary artery disease
• Chronic kidney disease
• Lowers the risk of death following a heart attack

Beta-Blockers

• Congestive heart failure
• Abnormally fast heart rate, or tachycardia
• Chest pain or angina
• Glaucoma
• Anxiety
• Migraines

Side Effects

ACE Inhibitors

• Dry cough
• Headache
• Dizziness
• Red, itchy skin, and/or a rash
• Fatigue
• Sweating
• Gastrointestinal problems

Beta-Blockers

• Decreased heart rate
• Low blood pressure
• Dizziness
• Mood changes
• Fatigue
• Decreased libido
• Gastrointestinal problems

Warnings

ACE Inhibitors

• Hazardous to pregnant women and may result in congenital abnormalities
• Hyperkalemia: ACE inhibitors may increase the amount of potassium in your body. Avoid using salt substitutes or potassium supplements while taking these medications.
• Angioedema: Your face, eyes, mouth, lips, tongue, neck, as well as your legs, feet, or hands, may swell.
• Jaundice: Yellowing of the skin or the whites of your eyes, which could indicate major liver issues.

Beta-Blockers

• Hazardous to pregnant women and may result in congenital abnormalities
• Black box warning (the strictest warnings for prescriptions) that warns against abruptly discontinuing your beta-blocker because that may increase your risk of a heart attack or other heart problems.

Which Medication is Best for Me?

When determining the best medication for managing high blood pressure, your physician will consider various factors, including your overall health and any additional symptoms you may have. ACE inhibitors are often the first choice for many individuals with high blood pressure, especially if they do not exhibit any other symptoms. These medications are effective in lowering blood pressure by relaxing blood vessels and reducing the workload on the heart.

However, if you experience additional symptoms such as anxiety or chest discomfort, a beta-blocker might be a more suitable option. Beta-blockers not only help lower blood pressure but also reduce heart rate and the force of heart contractions, which can alleviate anxiety and chest pain. This makes them particularly beneficial for individuals who have both high blood pressure and these additional symptoms.

In some cases, your physician may recommend taking both ACE inhibitors and beta-blockers simultaneously. This combination can be particularly effective because these medications work through different mechanisms and target various aspects of the cardiovascular system. By complementing each other, they can provide a more comprehensive approach to managing high blood pressure and associated symptoms.

Ultimately, the choice of medication will depend on your specific health needs and how your body responds to treatment. It’s essential to work closely with your healthcare provider to determine the most appropriate medication or combination of medications for your condition. If you have any concerns or questions about your treatment plan, don’t hesitate to discuss them with your doctor.

Summary

Hypertension is a silent condition that can lead to serious health problems like heart disease and stroke. Two common types of medication used to manage hypertension are ACE inhibitors and beta-blockers.

ACE inhibitors work by relaxing blood vessels, making it easier for blood to flow. This reduces the workload on the heart and lowers blood pressure. They're often prescribed for people with high blood pressure, especially those with diabetes or kidney disease.

Beta-blockers work by slowing down the heart rate and reducing the force of heart contractions. This can lower blood pressure and reduce the workload on the heart. They're often used for people with high blood pressure, heart failure, or irregular heart rhythms.

The best medication for you will depend on your specific health condition and other factors. Your doctor will consider your medical history, lifestyle, and other medications you're taking to determine the best course of treatment.