Patients should not assume that all blood pressure medications are alike. ACE inhibitors and beta blockers are two different classes of drugs used to treat hypertension and heart disease. Although they treat similar conditions, these drugs work differently and have different side effects.
History
The first ACE inhibitor was developed in 1975 and approved by the Food and Drug Administration in 1981. Since that time, a plethora of other ACE inhibitors made it to market, including drugs that combine an ACE inhibitor with another drug such as lisinopril hydrochlorothiazide.
Sir James Black developed the first beta blocker in 1962. This drug was approved by the FDA in 1968. The Nobel Prize in Medicine was awarded to Sir Black in 1988 for this discovery.
Mechanism of Action
Angiotensin converting enzyme catalyzes the formation of angiotensin II from angiotensin I. This reaction is the first in a series of reactions that ultimately constrict blood vessels. By inhibiting this reaction, ACE inhibitors lower blood pressure by preventing the constriction of arteries.
Beta blockers act upon the sympathetic nervous system, which is involved in the fight-or-flight response. By stilling this response, the heart rate slows down and blood vessels relax.
Names
The names of ACE inhibitors end in "opril." According to the Mayo Clinic, commonly prescribed ACE inhibitors include benazepril, ramipril, lisinopril, captopril, enalapril, quinapril and others.
The names of beta blockers end in "olol." The Mayo Clinic says that commonly prescribed beta blockers include acebutolol, metoprolol, propranolol, bisoprolol and others.
Prescribing Patterns
ACE inhibitors are often the first drug of choice when treating hypertension because they have relatively few side effects. The National Kidney Foundation recommends that they be prescribed to lower blood pressure or reduce urine protein, both of which are common problems in kidney patients.
Although new beta blockers continue to be approved by the FDA, this category of drugs is usually prescribed after other options have been eliminated. According to the Mayo Clinic, beta blockers are commonly prescribed after a heart attack, or to treat heart arrhythmias, and can be very effective for people who have severe stage fright.
Side Effects
ACE inhibitors are very well tolerated by most patients. Side effects such as fatigue and dizziness are caused by the drop in blood pressure. Cough and headache are also common.
Beta blockers tend to cause more problems. The Merck Manual cautions that these drugs can cause spasm of the airways, an abnormally slow heart rate, heart failure, and can makes low blood sugar levels in diabetics. Other possible side effects include impaired peripheral circulation, vivid dreams and sexual dysfunction. Also, some beta-blockers can cause an increased triglyceride level.
Call a doctor if you have side effects because these can frequently be eliminated by changing the dose.
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