Angiotensin-converting enzyme (ACE) inhibitors and beta-blockers are groups of prescription drugs widely used to treat certain heart conditions.
Although they are sometimes used in combination, both drugs belong to separate classes and have their own mechanisms of action (how they work). However, they are both effective in lowering blood pressure and treating other heart conditions.
This article discusses the differences and similarities between ACE inhibitors and beta-blockers, gives examples of each, and discusses whether you can take them at the same time.
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ACE Inhibitors vs Beta Blockers: What’s the Difference?
As the name suggests, angiotensin-converting enzyme inhibitors stop the hormone production that converts angiotensin I to angiotensin II. Angiotensin II narrows blood vessels, increasing blood pressure and forcing the heart to work harder. The inhibition of this hormone relaxes the veins and arteries and lowers blood pressure.
On the contrary, beta-blockers work on beta-adrenergic receptors. They are also called beta-adrenergic receptor-blocking agents. Beta-blockers reduce the release of the stress hormone adrenaline (epinephrine). They reduce the heart rate and the force needed to pump blood around the body. They also widen veins and arteries to improve blood flow.
Types of ACE inhibitors
Examples of Food and Drug Administration (FDA)-approved ACE inhibitor drugs include:
- Lotensin (benazepril)
- Captopril
- Vasotec (enalapril)
- Fosinopril
- Zestril (lisinopril)
- Moexipril
- Perindopril
- Quinapril
- Altace (ramipril)
- Trandolapril
Types of Beta-Blockers
Beta-blockers are divided into three categories based on the location of beta receptors in the body: B1, B2, and B3.
- B1 receptors are found in the heart and kidneys.
- B2 receptors are mainly located in smooth muscle tissue in the respiratory, blood vessels, and nervous systems.
- B3 receptors are present in fat cells and the bladder.
Based on their different locations, these are specified to perform different functions. Common FDA-approved beta blockers include:
- Acebutolol
- Tenormin (atenolol)
- Betaxolol
- Bisoprolol
- Coreg (carvedilol)
- Coreg CR (carvedilol phosphate)
- Labetalol
- Toprol XL (metoprolol succinate)
- Lopressor (metoprolol tartrate)
- Corgard (nadolol)
- Bystolic (nebivolol)
- Pindolol
- Inderal LA (propranolol)
What Conditions Do They Treat?
These drugs are widely used to treat different kinds of heart problems and high blood pressure.
ACE inhibitors are indicated for:
ACE inhibitors relax the veins and arteries, helping prevent certain kinds of heart disease from getting worse. They are used with other medications to treat and lower the risk of high blood pressure, strokes, or heart attacks.
ACE inhibitors may also improve kidney function, especially if you have diabetes.
Beta-blockers work at receptors located in different organs of the body. They are mostly used to treat conditions related to heart and blood vessels. They are indicated for:
Beta-blockers also treat some conditions related to the nervous system, such as migraines and essential tremors.
Which Is More Effective for Blood Pressure?
ACE inhibitors and beta-blockers are widely used to treat high blood pressure and other heart problems. Many studies support that both these drug classes are effective at managing the symptoms of heart conditions. ACE inhibitors can also sometimes improve quality of life.
While beta-blockers used to be a first-line treatment for hypertension, their role has changed in recent years. They are not usually used as the first line of treatment anymore. Instead, they are used after ACE inhibitors, angiotensin receptor blockers (ARBs), and calcium channel blockers (CCBs).
However, beta-blockers are still often recommended for certain conditions, such as:
- Heart failure
- Coronary artery disease
- Atrial fibrillation
- Hypertension-complicated heart conditions
Therefore, treatment choices for a person with heart disease should be based on the risk factors, other conditions, and individual characteristics of the drug.
Side Effects
ACE inhibitors and beta-blockers can have a few side effects. Some are serious and may require immediate medical attention. However, other milder side effects usually go away on their own.
Some common side effects of these drugs are mentioned below.
| Common Side Effects | ||
|---|---|---|
| Side Effect | Beta-blockers | ACE inhibitors |
| Cough | No | Yes |
| Dizziness | Yes | Yes |
| Feeling tired | Yes | Yes |
| Headache | Yes | Yes |
| Sleeping problems | Yes | Yes |
| Constipation or diarrhea | Yes | No |
| Feeling lightheaded | Yes | No |
| Upset stomach | Yes | No |
The following are potentially severe side effects that can occur. Be mindful if you develop any of these signs. Immediately call your healthcare provider or seek medical help.
| Serious Side Effects | ||
|---|---|---|
| Side Effect | Beta-blockers | ACE inhibitors |
| Slow heartbeat | Yes | No |
| Fast heartbeat | No | Yes |
| Chest pain | Yes | Yes |
| Breathing problems | Yes | Yes |
| Swelling in the face hands, feet, ankles, or legs | Yes | Yes |
| Signs of infection | No | Yes |
| Abdominal pain | No | Yes |
| Jaundice | No | Yes |
Precautions
ACE inhibitors and beta blockers are among the most widely used medications for heart conditions. However, they are not suitable for everyone and may not be safe to take in certain circumstances.
Tell your healthcare provider about your medical history and all other details before starting these drugs. Given below are some conditions in which you should avoid taking these drugs.
ACE Inhibitors
Before prescribing an ACE inhibitor, your healthcare provider will take the following into consideration:
- Pregnancy or breastfeeding
- Diabetes and are taking Tekturna (aliskiren)
- A history of angioedema (when a part of the body suddenly becomes swollen)
- Kidney impairment
Beta Blockers
Before prescribing beta blockers, your healthcare provider will take the following into consideration:
- Pregnancy or breastfeeding
- Bradycardia (slower than normal heart rate) or heart block
- Asthma
- Kidney or liver problems
- Diabetes
- Overactive thyroid
Drug Interactions
Some drugs interact with each other when taken together. It is important to ask a healthcare provider if you are taking multiple drugs for different conditions.
ACE inhibitors interact with the following drugs:
- Renin-inhibitors, such as aliskiren
- Diabetes medications
- Diuretics (water pills), such as Aldactone (spironolactone)
- Gold injections
- Lithium
- Angiotensin receptor-neprilysin inhibitors, such as Entresto (sacubitril and valsartan)
- mTOR inhibitors, such as Torisel (temsirolimus)
- Nonsteroidal anti-inflammatory drugs (NSAIDs), such as Advil (ibuprofen)
On the contrary, beta-blockers can have drug interactions with the following:
In addition, beta-blockers may interact with certain herbs, such as:
Can You Take Them Together?
Yes, beta-blockers and ACE inhibitors can be used together in some cases.
Therapeutic goals for treating heart disease are often not met with a single drug. Combining two treatments, like beta-blockers and ACE inhibitors, is a beneficial approach. The combined effect of these drugs on the sympathetic nervous system and the renin-angiotensin-aldosterone system effectively manage these conditions.
There is robust evidence of the benefits of beta-blocker and ACE inhibitor use in people with:
- Hypertension
- Elevated heart rate
- CAD
- Atrial fibrillation
- Heart failure.
For example, extensive evidence supports the benefits of taking bisoprolol (a beta-blocker) and perindopril (an ACE inhibitor) together. The combination has been shown to significantly reduce blood pressure in most people.
Switching Between ACE Inhibitors and Beta Blockers
It is completely safe to switch between ACE inhibitors and beta blockers, as recommended by your healthcare provider. The response to treatment may depend on your response to the drug.
A study on a group of people with mild-to-moderate high blood pressure evaluates the effects of a treatment change from a beta-blocker to an ACE inhibitor drug. The study aimed to find the effects on people’s health and lifestyle.
Results showed that blood pressure was equally well managed. People treated with captopril (an ACE inhibitor) showed equally well-controlled blood pressure on a lower drug dose and favorable changes in quality of life. These included improved sleep, gastrointestinal and physical activity-related symptoms, and the ability to concentrate.
Summary
ACE inhibitors and beta blockers are two separate drug classes used to treat health conditions related to the heart and blood vessels.
ACE inhibitors stop the hormone production of angiotensin II, which relaxes the veins and arteries and lowers blood pressure. Beta-blockers help lower heart rate and improve blood flow by reducing the release of adrenaline.
Both drugs are equally effective at treating high blood pressure and heart problems, and they are sometimes used in combination. The treatment choices for a person with heart disease will be based on the risk factors, comorbid conditions, and individual considerations for taking the drug.
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