Rate Control Meds

[Barny12]

Anyone know why beta blockers are generally prescribed over calcium channel blockers?

[BobD Volunteer]

Some people can't take Calcium channel blockers I guess. I'm one.

[Peony4575 in reply to BobD]

But some people can’t take beta blockers and I am one

[Elli86 in reply to BobD]

Think I must be as well considering the reaction I had.

[mav7]

Subject can be discussed infinitely. The doctors likely feel the same. 😊

Not sure, but from reading it seems beta blockers are prescribed initially due to possibly less effects on the system like fluid retention (diltiazem). That said, decision rests with the doctor and the patient.

Some patients seem to tolerate CCBs better with less side effects like fatigue.

[Ppiman]

I gather that there's a hard-to-diagnose sub-group of people with a form of heart failure that is aggravated by CCBs, making betablockers the safer choice.

Steve

[oscarfox49]

Beta blockers are an extremely safe 'solution' which have been proven to act long term without any major side effects (for most people). I know too little about calcium channel blockers to make any comparison in safety terms.

[pusillanimous in reply to oscarfox49]

I think cardio specific BBs are more effective ,although the side effects can be daunting at first. I was already on Verapamil for high BP when diagnosed with AF and it had zero effect on the latter. A low dose of Biso (1.25mg) was immediately effective on my heart rate. I now take it at night, sleep solidly for 7 hours and avoid the feeling of lethargy so commonly associated with the drug.

[cassie46]

I am on both of them. I have AF and HF, I was on Bisoprolol and Digoxin at first, reacted to Digoxin so I was put on Viazem (Diltiazem). This was with careful monitoring because I have HF but it was fine but when there was a shortage of Viazem and I was was given two of the other Diltiazem brands I reacted badly to them. Never really got on with Biso so that has now been changed to Nebivolol.

[Quilter43]

Why would one be better? Don't understand calcium alternative.

[Tplongy]

I am the opposite way, was on beta blockers for 8 months for persistent AF, felt dreadful, lowered my BP massively, irrespective of adjusting dosage and timings, still no change.

So, my Cardiologist changed me to CCB - but warned me that though it may be more gentle on my BP - which it has been - she said that CCB are not as effective at controlling heart rate as beta blockers are...

hope this helps, just my experience,

[Barny12 in reply to Tplongy]

Do you feel better on the CCBs?

[Tplongy in reply to Barny12]

Hi Barney

Was Ok for 2 months then started to feel terrible, dizzy, lightheaded all the time. 24 hr ECG showed 90 mg Diltiazem twice a day not controlling my heart rate at all - highs of 170, though average of 113. Cardiologist recommended increase to 120 mg twice a day which I have been doing now for 4 weeks and feel absolutely shocking. Next step is increase to 180mg twice a day. Echo done this week and then another holter... ho hum.

[Barny12 in reply to Tplongy]

Sorry to hear that. Hope the new dosage helps.

[Barny12]

Ok from what I've been able to glean (very little):

Beta blockers work by reducing the ability of adrenaline to speed up heart rate.

Calcium channel blockers work by relaxing and dilating the blood vessels, allowing the heart to work less hard.

Beta blockers are more suitable to patients with heart failure with reduced ejection fraction.

Both slow the heart rate, but BBs slow it down potentially into bradycardia, whereas CCBs don't slow the heart rate as far and as they allow a more stable blood pressure and as they are still receptive to adrenaline input they allow the heart to speed up if the rate drops too low.

This lead me to an interesting nugget from the European Heart Rhythm Assoc. I found whilst delving into the arcane world of rate control:

Beta-blockers in atrial fibrillation—trying to make sense of unsettling results

Some snippets:

"Heart failure with a reduced ejection fraction is the only condition in which" beta blockers "provide unequivocal benefits that result in higher ejection fractions and a longer life."

"Sinus rate lowering in patients with a normal ejection fraction increases the risk for atrial fibrillation"

"we contend that beta-blockers are overused in atrial fibrillation. The available data suggest that the adverse effect of beta-blockers is most pronounced in patients with a normal ejection fraction and low heart rates, typified by patients with paroxysmal atrial fibrillation on high maintenance doses of beta-blockers that markedly suppress the sinus rate"

"it is generally overlooked that calcium-channel blockers, have a pharmacological advantage over beta-blockers. They preferentially bind to activated calcium channels making their effect on heart rate use dependent. In other words, they have little effect at lower heart rates, while exerting a robust dromotropic effect at rates encountered with fast conducting atrial fibrillation and thus provide protection from tachycardia-induced cardiomyopathy when it is most needed. By extension, calcium-channel blockers have little effect on sinus rate, filling pressures, and wall stress to explain why the progression towards permanent atrial fibrillation may be slower and why they are better tolerated than beta-blockers"

Conclusion

"Considering the uncertain evidence basis, the known unfavourable side-effect profile, and the availability of alternative medications we avoid beta-blockers in patients with atrial fibrillation in the absence of a clear and specific indication. When considering the high prevalence of atrial fibrillation, there is an urgent need for larger randomized outcomes trials that compare rate-control strategies."

academic.oup.com/europace/a...

[Tplongy in reply to Barny12]

Thanks Barny, most interesting reading

[MalcolmCClark]

My experience with both are.I tolerated beta blocker bisoprolol very well with no side effects

Calcium channel blockers gave me serious headaches the same as gtn spray. I could not tolerate them

I have AF and bradycardia so I eventually had to stop the beta blocker.

I have chest pains but tolerate them as the headaches were worse.

All I would say is that speak to your doctor and go by their guidance.

We all have different reactions to drugs so what ever the doctor suggests give it a go and see how you get on.

It's a medication dilemma so good luck

[Madscientist16]

I think heart health is a big consideration for doctors on what they prescribe. In the US younger and healthier patients get CCB's first while older get beta blockers first. CCB's can have harsher side effects such as edema for those that are inactive or may have early heart failure from the AF itself or from other health issues.