CCBs vs BBs

Specialties NP


Specializes in Hospitalist.

I've noticed that a lot of pts are sometimes on both a calcium channel blocker and a beta blocker P.O. Why is this?

What are the main differences between these two med groups (metoprolol vs cardizem, for example) that would lead a practitioner to prescribe either/or?

Are CCBs are used more for rate control and BBs are more for BP control?

But then, some ppl take verapamil (CCB) for BP control.

And I'm not necessarily talking about the MI core measure either. I know those pts always get a BB.

I guess my question is, against what criteria would a practitioner evaluate a pt to receive either or both a CCB or a BB?

Specializes in CVICU, Home Health, Pre/Post OP Recovery.

Sometimes it takes 2 or 3 different classes with different mechanisms of action to control the BP.

Specializes in ACNP-BC, Adult Critical Care, Cardiology.

Agree with above. In primary care, the "bible" used by providers in treating HTN is what is called the "JNC" report. This is a long document compiled by experts and published by NIH which contains leading research data on blood pressure control. It is updated regularly and we are currently on the 7th edition (with the 8th coming out).

HTN is classified according to stages depending on the BP measurements. Stage I requires starting a single agent and the recommendation is for thiazide diuretic first, though CCB's and BB's are actually acceptable as initial agents. Stage II requires 2-drug combination. The addition of agents and/or optimization of the dose should be considered if BP remains above the normal range after treatment has been initiated.

JNC also recommends choosing antihypertensive agents based on compelling indications. This means that research data suggests that HTN in combination with certain comorbid conditions are best treated with a particular class or classes of antihypertensive agents. For example BB's are indicated in HF (compensated), post-MI, and DM; while CCB is indicated in DM; ACEI are indicated in HF, post-MI, and CKD. Some racial groups have been found to have a better BP response to certain classes of meds (i.e., African Americans respond better to thiazide diuretics and CCB's. ACEI-related angioedema occurs more frequently in this group as well).

Another thing to consider when picking an agent is the side effect profile and convenience of administration for the patient (single daily dose will achieve better compliance than multiple daily doses). If compliance is an issue certain drugs should be avoided (i.e., Alpha2 Agonsists such as Clonidine require multiple daily dosing and is known for rebound HTN if doses are missed so not a good idea to prescribe to people who are not compliant with meds).

Regarding your question on rate control, both CCB's and BB's have been used for rate control. However, there are 2 types of CCB's: (1) Dihydropiridines (i.e., Amlodipine) are not used for rate control because they don't have an effect on HR. (2) Non-dihydropiridines (i.e., Dilitiazem) can be used for rate control because they do lower HR.

For a quick reference see:

Specializes in Nephrology, Cardiology, ER, ICU.

Renal function should always be considered in tx of HTN too.

Specializes in Nephrology, Cardiology, ER, ICU.

And it's available in the iPhone app store for free

Specializes in Psychiatric Nursing.

@traumaRUs. What is the name of the free blood pressure app for iPhone ?

Specializes in CVICU, Home Health, Pre/Post OP Recovery.

@ traumaRUs: what is it under in the App store?

Specializes in Nephrology, Cardiology, ER, ICU.

I just typed in "blood pressure treatment" and up it popped.

Specializes in allergy and asthma, urgent care.

I also would look at side effect profiles. I avoid BBs in male patients (without compelling indications) because of the increased risk of sexual dysfunction. Some CCBs can cause significant constipation. And...oftentimes what you prescribe is determined by what the patient's insurance will pay for.

Specializes in Nephrology, Cardiology, ER, ICU.

I apologize for the earlier misinformation - the app I have is 'Guide to multidrug antihypertensive therapy in blacks." Helpful for some but not others. Sorry....I read it too fast.

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