Beta blockers may be considered as initial therapy for hypertension particularly if intolerant or C/I to ACEI/ARB for:
• younger people (under 55)
• women of childbearing age
• people with evidence of increased sympathetic drive
• at Step 4 if further diuretic therapy is not tolerated, C/I or ineffective

Evidence suggests the combination of beta-blocker and thiazide increases risk of Type 2 DM and this is generally considered to be dose related.
Cardioselective beta-blockers may be used in well-controlled asthmatic patients, or COPD without significant reversible component for Heart Failure or following an MI. Treatment should be initiated at a low-dose & the patient monitored carefully for adverse effects.
Recent evidence-based guidance for angina states that beta-blockers should be the first line therapy for the long-term prevention of angina.
Patients with heart failure should only be prescribed with beta-blockers licensed for this indication.

NICE guidance on Atrial Fibrillation: https://www.nice.org.uk/guidance/cg180

Therapeutic AreaFormulary ChoicesCost for 28
(unless otherwise stated)
Rationale for decision / comments
Beta-blockersBisoprolol
1.25mg tablets: £0.86
2.5mg tablets: £0.84
3.75mg tablets: £1.12
5mg tablets: £0.76
7.5mg tablets: £4.32
10mg tablets: £0.79
Bisoprolol is included in the formulary for:
Heart failure: Patients’ with heart failure should be prescribed a beta-blocker licensed for heart failure. Bisoprolol is first line drug, initiate at 1.25mg and slowly titrate, assessing heart rate, blood pressure and clinical status after each titration.
Hypertension: in line with NICE guidance. Alternative to Atenolol
Angina: as alternative to Metoprolol
Post-MI: as alternative to Metoprolol
Atenolol25mg tablets: £0.76
50mg tablets: £0.83
100mg tablets:£0.79
Atenolol is included in the formulary for:
Hypertension: in line with NICE guidance. Atenolol dose for hypertension should not normally exceed 50mg daily.
Angina: for prophylaxis of symptoms, some additional benefit may be obtained by increasing the dose to 100mg.
Metoprolol50mg tablets: £1.25
100mg tablets: £1.37
Metoprolol is included in the formulary for:
Hypertension: in line with NICE guidance. Alternative to Atenolol or Bisoprolol
Angina: as alternative to Bisoprolol
Post-MI: as alternative to Bisoprolol

Sotalol is no longer recommended for AF.