Beta-blocker side-effects in clinical practice: A nationwide approach - 07/10/25
, Jarl Emanuel Strange, MD, PhD a, Sebastian Kinnberg Nielsen, MD b, Rasmus Borup Hansen, MBSc b, Gunnar H. Gislason, MD, PhD b, Morten Lamberts, MD, PhD b, Morten Lock Hansen, MD, PhD a, Anders Holt, MD, PhD bHighlights |
• | In a nationwide cohort of patients treated with beta-blockers for hypertension, we uncovered clinically relevant increased risks of depression, anxiety/insomnia, gastrointestinal side-effects, and dizziness/fainting compared with calcium-channel blockers. |
• | The most used beta-blocker was metoprolol (∼ 76%), and to a lesser extent propranolol (∼ 7%), carvedilol (∼ 6%), and bisoprolol (∼ 6.%). |
• | Interestingly, beta-blockers did not confer increased risks of erectile dysfunction contrary to common clinical perception. |
ABSTRACT |
Background |
Concerns regarding side-effects of beta-blockers (BBs) are frequent but data regarding the incidence of side-effects are conflicting and real-world data are sparse. Hence, we aimed to investigate the absolute and relative risks of BB side-effects in clinical practice.
Methods |
Using Danish nationwide registers, we included Danish hypertensive patients initiating antihypertensive treatment with a BB or calcium-channel blocker (CCB). We computed crude as well as standardized 1-year risks and adjusted risk ratios of BB side-effects (depression, anxiety/insomnia, gastrointestinal side-effects, erectile dysfunction, and dizziness/fainting) compared with CCB treatment.
Results |
We included 64,722 patients initiating treatment with a BB and 181,880 patients initiating treatment with a CCB. In patients initiated on BB, the standardized 1-year risk of any outcome, erectile dysfunction exempt, was 13.7% (95% CI: 13.4%-13.9%). The 1-year risk of specific BB side-effects was the highest for anxiety/insomnia (6.2%, 95% CI: 6.0%-6.3%), gastrointestinal side-effects (4.6%, 95% CI: 4.4%-4.7%), and erectile dysfunction (4.7%, 95% CI: 4.5%-4.9%).
The risk of side-effects was consistently increased when comparing BB treatment with CCBs including depression (Risk Ratio [RR] 1.48, 95% CI 1.41-1.55), anxiety/insomnia (RR 1.53, 95% CI 1.47-1.59), gastrointestinal side-effects (1.31, 95% CI 1.25-1.36), and dizziness/fainting (RR 1.50, 95% CI 1.38-1.61), but not erectile dysfunction (RR 0.91, 95% CI, 0.85-0.96).
Conclusions |
In a large nationwide cohort, the incidence of BB side-effects was clinically relevant and consistently increased compared with CCBs with the exception of erectile dysfunction, which carried similar risks for both treatments.
Le texte complet de cet article est disponible en PDF.Graphical abstract |
Associations between added hypertensive treatment of beta blockers or calcium channel blockers and potential side-effects. Standardized absolute risk pr. 60 days of follow-up derived using G-formula and cause-specific Cox models adjusted for sex; age; educational level; and medical history of diabetes mellitus, cancer, chronic kidney disease, stroke, and chronic obstructive pulmonary. aWomen were excluded from these analyses. bComposite of all outcomes except erectile dysfunction. Please note the different y-axis.
Plan
Vol 291
P. 111-120 - janvier 2026 Retour au numéro
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