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 Area||Formulary Choices||Cost for 28|
(unless otherwise stated)
|Rationale for decision / comments|
|Beta-blockers||Bisoprolol||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
|Atenolol||25mg tablets: £0.76|
50mg tablets: £0.83
|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.
|Metoprolol||50mg 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.