Emergency icon Important Updates
Beta-blockers are a medication that dials down your heart rate and relaxes your cardiovascular system. Listen in as cardiologist Tamanna Singh explains why they are a cornerstone treatment for many cardiac conditions.

Subscribe:    Apple Podcasts    |    Podcast Addict    |    Spotify    |    Buzzsprout

Beta-Blockers: A ‘Chill Pill’ for Your Heart with Tamanna Singh, MD

Podcast Transcript

John Horton:

Hey there, and welcome to another Health Essentials Podcast. I'm John Horton, your host.

Slowing things down can be good for your heart, a simple way of explaining why beta-blockers are so commonly prescribed. The medication dials down your heart rate and relaxes your cardiovascular system. It's the ultimate chill pill and a cornerstone treatment for a wide range of health conditions.

We're going to spend today chatting with cardiologist Tamanna Singh to learn more about beta-blockers and how they're used. Dr. Singh is one of the many experts at Cleveland Clinic who pop into our weekly podcast to demystify medicine. Now, let's find out how beta-blockers work and why, in some cases, they may be able to add years to your life.

Dr. Singh, it is always great to see your name on the guest list. I just love that this has become a regular thing.

Dr. Tamanna Singh:

Oh, my gosh. I love it, too. I love talking to you.

John Horton:

Well, we love that you come in and give us a little bit of time. And today, you're here to talk with us about beta-blockers. And I got to tell you, I love that this medication is referred to in some circles as “chill pills,” given the effect that they have on the heart.

Can you walk us through how the medication can help your ticker stay cool, calm and collected.

Dr. Tamanna Singh:

Cool, calm and collected. I've actually never heard the chill pill analogy, but I may start to use that. So thank you.

So beta-blockers are a class of medications that block beta receptors. If we had to describe beta receptors, there's a number of these receptors on different organs, and we can focus on the heart. And these receptors tend to get stimulated or activated by stress hormones. Stress hormones commonly are things like epinephrine or norepinephrine. And once these little suckers bind to those receptors, they start to rev up your heart rate, rev up your blood pressure. When they act on our blood vessels, they cause constriction of those vessels, so everything gets heightened and stressed and "alive."

So beta-blockers prevent that all from happening. Instead of allowing epinephrine and norepinephrine to attach to beta receptors, these blockers block those suckers, and they prevent this increase in heart rate, prevent this increase in blood pressure. So they certainly do help people get more calm, cool and collected.

John Horton:

Yeah, so it sounds like it tamps down that adrenaline level that people might feel when they get worked up?

Dr. Tamanna Singh:

Exactly.

John Horton:

So why would someone be prescribed a beta-blocker? Because I know we all have that adrenaline that hits. What makes somebody a candidate to get those?

Dr. Tamanna Singh:

Yeah, so we use beta-blockers really in different ways for different individuals. So, since we're talking about the heart, the most common we may use beta-blockers is to help enhance oxygen delivery to the heart muscle, which typically occurs between heartbeats.

So you can imagine if we slow down the heart rate with a beta-blocker, you have more time, and there's more time between heartbeats to amplify that oxygen delivery to the heart. So for people who have heart attacks, we really want their tissues to heal. For people who have weaker hearts, we might want to try to help those hearts improve and function, and so beta-blockers can certainly do this.

John Horton:

Wow, so by slowing it down, you increase the amount of oxygen going through, and let the heart catch up with things and really get everything that it needs?

Dr. Tamanna Singh:

Yeah, this is the best way I think beta-blockers can be used for people who have some impact on the actual function of the pump. And the pump function can certainly be impacted by actual disease within the heart muscle, and then, certainly, by the plumbing.

If the plumbing's not working right, the pump's not going to be working well or the pump might be failing. And so beta-blockers can actually help with this process that we call reverse remodeling. Or they can help to limit the amount of heart cells that may die. They help to improve the function of the heart, all by just enhancing oxygen delivery to the heart muscle.

The other systems that we think about within the heart that beta-blockers can be helpful for are when there is any issue with the electrical wiring, the electricity of the heart. So I'm talking about arrhythmias, abnormal heart rhythms. I'm talking about skipped beats or premature beats. Anything where we may need to slow down the heart rate or subdue, suppress some of these arrhythmias, those would be situations where we may also lean on beta-blockers.

And then, I think one of the final things I'll say is, well, it can be related to the heart, but sometimes, we have individuals who have generalized anxiety disorder, or maybe people who become fearful of speaking in front of the public, and they start to get a little sweaty, their heart rate rises … beta-blockers can actually be very helpful for people who have anxiety. So that's another way that we can use them.

John Horton:

See another reason to call it a chill pill.

Dr. Tamanna Singh:

Sure.

John Horton:

Because it does fit.

When we're talking about beta-blockers in the heart, when you think of heart issues, blood pressure is always a huge thing. Are beta-blockers used to control that?

Dr. Tamanna Singh:

Beta-blockers, I think in the past, may have been used more aggressively or more consistently to control blood pressure. We have a lot of other first-line antihypertensive agents, agents that control blood pressure. There are some beta-blockers that are quite effective in helping to reduce blood pressure, but more oftentimes than not, when we're thinking about whether we want to implement a beta-blocker in someone's host of medications, the other questions that we're asking are, what does the pump function look like? What does the plumbing look like? And that might help us be a bit more nuanced about the type of blood pressure medication we want to use and whether that would include a beta blocker.

John Horton:

Yeah, it's just so wild that you take this medication and basically, you're trying to slow the heart down, almost so it can concentrate a little bit more on what it's doing and really make sure it's working correctly.

Dr. Tamanna Singh:

Oh, certainly. I mean, I think beta-blockers have been around for decades and decades. They are a mainstay of therapy, particularly after acute heart attacks when we see impaired heart function, meaning the heart's weaker because part of it's just not moving well. It's part of what we describe as guideline-directed medical therapy for individuals who have "heart failure" or some compromise in heart function, again.

And, like I mentioned, it can be used for electrical disturbances with the heart. So there's so many ways that beta-blockers can be impactful. They're definitely incorporated in all aspects of cardiology.

John Horton:

And it sounds like they're very common, like if you've had a heart attack, is it pretty routine then that you get put on beta-blockers afterward?

Dr. Tamanna Singh:

It really depends upon the heart attack. Back in the day, I would say that after most acute heart attacks, people would be on beta-blocker therapy for about three years or so. But what we're finding now is those beta-blockers could be the most impactful for people who've had heart attacks that have impacted heart function, meaning the heart function has become weak. This is where that reverse or remodeling process can certainly be helpful in improving mortality, improving cellular health, and hopefully, helping that individual regain that pump function of their heart.

John Horton:

Now, by slowing the heart down, you always think, like when you exercise and you do things, does that impact it? Like, if you're on a beta-blocker, then is it harder to exercise or rev things up?

Dr. Tamanna Singh:

It really depends. So I see a lot of athletes in my practice, and that's the question they have for me. Being on a beta-blocker, is that going to lead to them not being able to hit their maximal heart rate that they see when they're cycling or when they're running?

And it really depends. And what we found in our athletes is that they're quite well ... they're tolerating low to moderate doses of beta-blockers quite well. There are some individuals who may say that they feel like they're hitting a wall when they're getting to maximal intensity efforts because they just can't get their heart rate as high as before — because, as I mentioned — one of the ways beta-blockers work is by preventing your heart rate from increasing as it would with sympathetic surges. Exercise is a sympathetic-driven modality. What that means is heart rate needs to go up, blood pressure goes up to help you actually do the activity that you're trying to do. So that is one of the things that I often will hear.

In terms of causing fatigue or lethargy, sometimes some people have lower resting heart rates, and when we add a beta-blocker, it makes their resting heart rate so low that they do feel a bit tired. They do feel a bit fatigued. Because that heart rate is just physiologically too low, and it's not high enough to allow for that person to do their activities on a daily basis.

So it really is trial and error for that particular population. But most people tolerate these meds quite well.

John Horton:

How common are beta-blockers? Because, like you said, they've been around a long time. So how many people are on these?

Dr. Tamanna Singh:

Yeah, so according to the Cleveland Clinic, about 30 million people in the United States are on beta-blockers. 10% of the adult population's on beta-blockers. And I think I saw a statistic quoting about 50 million prescriptions for beta-blockers are dispensed annually in the UK. So that's quite a bit of people.

John Horton:

That is a lot. That's a lot, a lot of people.

Are there some certain names that jump out as real common ones that are prescribed the most?

Dr. Tamanna Singh:

Yeah, so metoprolol or Toprol® is probably one of the most commonly prescribed beta-blockers. Carvedilol or Coreg® is another one. That one's a bit more impactful on blood pressure reduction than metoprolol. Labetalol, propranolol — really anything that ends in “lol” — nebivolol, nadolol, bisoprolol. I could go on and on and on.

John Horton:

They have all these names. And I wish they just gave them real simple names, but they're always a little complicated.

Dr. Tamanna Singh:

Yeah, that's true.

John Horton:

Now, we've touched on the whole safety of them, but I want to look at it a little bit more because, as we've all heard, when you listen to those medication ads, and you listen to them rolling through the fine print, there are issues. So what sort of side effects might you deal with when it comes to beta-blockers?

Dr. Tamanna Singh:

Yeah, I think the one thing to remember is that every medication has a side effect, whether it is listed or not listed, because we're all individuals who are going to respond to medications very differently. This medication has been around for decades and decades and decades, and it's been very well studied, very well integrated, not just in the cardiac space, but even in the neurological space, and even in other organ fields. So that's one thing that I really wanted to emphasize.

In terms of common side effects, typically, because we are lowering the heart rate, we do hear about some fatigue, some lethargy, which, after about three to four weeks of acclimation to the beta-blocker, can kind of go away, which is reassuring.

The dose’s dizziness can come from perhaps blood pressure that is a little too low on that dose. I think from a male perspective, we certainly can see erectile dysfunction or sexual dysfunction, again, quite minimal, but that's certainly one thing that my male patients will ask about.

Dry mouth.

I've definitely had a handful of individuals [inaudible 00:11:26] diarrhea.

I've had very few individuals talk about having nightmares. This is actually probably maybe in my younger individuals. I haven't heard of nightmares in my older population of patients, but that's certainly one anecdotally that I've heard.

But outside of maybe fatigue, dizziness, perhaps feeling cold, those would probably be some of the most common side effects.

John Horton:

Do you have to worry about interactions with other medications you might be on?

Dr. Tamanna Singh:

It certainly depends. I think if you're taking this medication with other heart rate-lowering medications, they're certainly going to be really not the best combination. But beta-blockers can really be impactful with any medication. It would be so hard to identify which ones without knowing someone's individual medication list.

John Horton:

Yeah. Well, and that's why I know, they always … you just talk to your doctor about all the prescriptions and medications you might be on just to see if there are any maybe crossover issues.

Dr. Tamanna Singh:

Of course. I think one thing that I always keep in mind when I'm prescribing beta-blockers is whether individuals have lung disease, so things like asthma or COPD, chronic obstructive pulmonary disease. Those diseases tend to be reliant on medications that are beta agonists. So if you're taking an agonist and a beta-blocker, they can essentially cancel each other out.

We have a lot of patients with obstructive lung disease who are on beta-blockers, and they're doing completely fine. But if you find that someone is on a high dose beta-blocker, or if you are on a high dose beta-blocker and your lung disease seems to not be responding as well as it used to on your pulmonary medications, that would be an opportunity to talk to your provider and say, "Hey, maybe something needs to be adjusted here," because you may be someone who's feeling that canceling effect.

John Horton:

Yeah. Once you start taking beta-blockers, are you on them for life?

Dr. Tamanna Singh:

It really depends. So if you're taking a beta-blocker, for instance, after an acute heart attack, you may really just complete an up-to-three-year course of that medication. If you're taking a beta-blocker as part of the guideline-directed medical therapy to support your weaker heart, it's likely going to be a more long-term medication, perhaps lifelong. If you're taking beta-blockers and eye drops for glaucoma, probably going to be lifelong. If you're taking beta-blockers for anxiety, and depending upon what other therapeutic modalities you're using to help control anxiety, it may be a short-term or an as-needed medication. It really just depends upon context.

John Horton:

Now, medications are just wondrous given what they do, but I know we don't want to rely solely on them. So what other things can folks do to try to resolve health issues, I guess, and specifically, heart issues that beta-blockers might address?

Dr. Tamanna Singh:

So for nearly all cardiovascular pathologies, exercise is going to be part of the recovery, the rehab, the prehab, all of it.

John Horton:

I've heard that once or twice with you, I think.

Dr. Tamanna Singh:

That is my [inaudible 00:14:34]. So movement, exercise, intentional physical activity, are very helpful in making your heart efficient. And when it's efficient, it doesn't have to pump as often to get blood to where it needs to go at times when you need it most. Your heart becomes stronger with exercise, so you can pump out more blood with just one contraction. And so fitness is a natural way to create this beta-blockade effect. You've probably heard of a lot of people who are active or people who are getting into fitness, the fitter they get, the lower their resting heart rate. So that essentially is this beta-blocker phenomenon.

John Horton:

I never thought of it that way, but you are right. It does, almost like, the stronger your heart gets, it can kind of relax a little bit more because it's just, I guess, it's pumping enough blood just on its own with each little burst.

Dr. Tamanna Singh:

Yeah, exactly. And I do have a number of patients who sometimes are started on beta-blockers, they start to incorporate lifestyle changes and exercise, and they come to me and say, "Hey, Doc, my heart rate's in the 40s now. Before it was in the 60s. Can I come off of my beta-blocker?" And I essentially say, "Hey, you are really optimizing oxygen delivery to your heart by having lowered your resting heart rate," and then we can make a shared decision, making [inaudible 00:15:45] to stop it if that's appropriate.

Other ways that exercise can be helpful outside of lowering your resting heart rate, again, it really improves oxygen delivery, not only to the heart muscle, but to the rest of your body. For people who have heart disease, the reason why we want people to exercise after heart attacks or for people with heart failure is because we can actually enhance blood flow to the heart muscle by generating tiny little vessels called collaterals. And this system of collateralization can often be a backup for that individual with significant heart disease by now having new roots of blood flow to the areas of the heart that just weren't getting adequate oxygenation. So there's a whole host of cardiac phenomena that can come from exercise alone.

John Horton:

Yeah, that makes total sense.

So Dr. Singh, if we're your patient. How would you go about explaining why taking a beta-blocker may be a good idea for our overall health? And from everything I've heard, it's the sort of thing that could even extend life expectancy.

Dr. Tamanna Singh:

Certainly. Again, I think the first question is, why are we using a beta-blocker or why is it needed?

John Horton:

Yeah. What's the sell? Give me the elevator pitch, I guess, as to why this would be a good idea to take.

Dr. Tamanna Singh:

Yeah. The elevator pitch, I think, would vary depending upon who I'm talking to. So if this individual has an issue with the pump, so the heart's just not functioning appropriately, then the beta-blocker can certainly improve mortality. It can certainly help with this reverse remodeling process. It can help with reducing perhaps events where people are accumulating a lot of fluid in the body or a lot of cardiac "stress" in the body.

If I'm talking to someone who's got some electrical wiring issues, it can help reduce symptoms of palpitations. It can help reduce malignant arrhythmias or deadly arrhythmias that can cause sudden cardiac arrest and death. It can control early beats that may be very stressful for an individual. It can even potentially control arrhythmias to the point where someone may not need an invasive procedure to completely eliminate them.

If I'm talking to someone who has cardiac disease or coronary artery disease who had an acute heart attack with some pump dysfunction, my sell would be very similar to someone who has heart failure. It can help to improve mortality, help with this reverse remodeling process, perhaps help your heart get back to "normal."

So there's so many benefits from beta-blockers from a cardiac perspective. Everybody does not need to be on a beta-blocker. It's not necessarily a risk stratification tool or risk reduction tool. It's really most appropriate in specific settings. But because a lot of our individuals have heart disease in the world, right? It's the number 1 killer. Many of our individuals have heart failure. Many individuals have issues with the electricity of their heart. This is why we see it being utilized in about three 30 million people here in the states.

John Horton:

Well, Dr. Singh, you explained that extremely well, and I think we all have a little bit of a better understanding as to how beta-blockers work and really, just all the good they can do in those very specific situations, which sounds like affects millions and millions of people.

Dr. Tamanna Singh:

Well, I'm always happy to help.

John Horton:

Well, thank you so much for coming in and sharing your wisdom.

Dr. Tamanna Singh:

Thanks for having me.

John Horton:

When it comes to treating heart conditions, beta-blockers have three major selling points. They're effective, they're generally safe and they're inexpensive. It's no wonder they're one of the world's most prescribed medications.

If you liked what you heard today, please hit the subscribe button and leave a comment to share your thoughts. Until next time, be well.

Speaker 3:

Thank you for listening to Health Essentials, brought to you by Cleveland Clinic and Cleveland Clinic Children's. To make sure you never miss an episode, subscribe wherever you get your podcasts or visit clevelandclinic.org/hepodcast. This podcast is for informational purposes only and is not intended to replace the advice of your own physician.

Health Essentials
health essentials podcasts VIEW ALL EPISODES

Health Essentials

Tune in for practical health advice from Cleveland Clinic experts. What's really the healthiest diet for you? How can you safely recover after a heart attack? Can you boost your immune system?

Cleveland Clinic is a nonprofit, multispecialty academic medical center that's recognized in the U.S. and throughout the world for its expertise and care. Our experts offer trusted advice on health, wellness and nutrition for the whole family.

Our podcasts are for informational purposes only and should not be relied upon as medical advice. They are not designed to replace a physician's medical assessment and medical judgment. Always consult first with your physician about anything related to your personal health.

More Cleveland Clinic Podcasts
Back to Top