What does the research show about beta-blockers?

Beta-blockers

Pooled trials found beta-blockers lowered deaths by about a third in heart failure with reduced pumping function. After a heart attack with preserved heart function, recent trials disagree. They prevented fewer strokes than other blood pressure drugs. Propranolol lowered migraine frequency. Labels warn that stopping abruptly can worsen angina.

Add to Bio HackChecked 2026-11-13

Status: Prescription drugs in the US. FDA-approved uses differ by drug and include high blood pressure, angina, heart failure (metoprolol succinate, carvedilol) and use after a heart attack. Propranolol is also approved for migraine prevention and essential tremor. Propranolol is not FDA-approved for performance anxiety.
Also called: metoprolol, Lopressor, Toprol-XL, carvedilol, Coreg, atenolol, Tenormin, propranolol, Inderal LA, InnoPran XL, bisoprolol, nebivolol, Bystolic, beta-adrenergic blocker, beta blocker
Taken for: high blood pressure, heart failure, recovery after a heart attack, angina, heart rate control, migraine prevention, performance anxiety and stage fright, tremor

Strong several reviews agree · Moderate one review or consistent trials · Limited one or a few small studies · Untested no study in people, listed with what it rests on

Shown to help6

StrongShown to lower deaths by about a third in heart failure with reduced pumping function, with no difference found between individual beta-blockers.
StrongShown to lower blood pressure by about 10/8 mm Hg and heart rate by 11 beats a minute in adults with mild to moderate high blood pressure.
ModerateShown to lower episodic migraine by about 1.5 headaches a month on propranolol against placebo, with 40% against 23% halving their migraine days in one trial.Very common
ModerateShown to reduce limb tremor in essential tremor on propranolol, rated Level A in one evidence review and clinically useful in another.
LimitedOne small crossover trial found metoprolol and carvedilol lowered 24-hour heart rate in permanent atrial fibrillation, from 96 beats a minute to 82 and 84.
LimitedSmall trials found propranolol removed physical symptoms of stage fright in musicians and raised performance quality as scored by critics.

Reported risks12

ModerateShown to raise reported fatigue slightly, by 18 per 1,000 people a year, or one extra report for every 57 people treated.Very common
ModerateShown to lower lung function in asthma, with a fall of 20% or more in about 1 in 8 people after a single selective beta-blocker dose.Very common
ModerateShown to raise slow heart rate and low blood pressure, with a slow heart rate in 9% on carvedilol against 1% on placebo in heart failure trials.Common
ModerateShown to raise new diabetes by 22% against other non-diuretic blood pressure drugs in people treated for high blood pressure.Common
LimitedOne trial found metoprolol started just before non-cardiac surgery lowered heart attacks and raised deaths, 3.1% against 2.3%, and strokes, 1.0% against 0.5%.Common
ModerateShown to raise reported sexual dysfunction slightly, by 5 per 1,000 people a year, or one extra report for every 199 people treated.How often is not known
ModerateShown to raise body weight by a median 1.2 kg against controls in 8 trials, with the gain in the first few months.How often is not known
LimitedThe label warns that worse angina and, in some cases, heart attack have followed abrupt stopping of beta-blockers.How often is not known
LimitedThe label warns that beta-blockers may hide early signs of low blood sugar, such as a fast heartbeat, and may add to the effect of insulin.How often is not known
LimitedThe label warns that these drugs slow the heart and that taking them with a beta-blocker can raise the risk of a slow heart rate.How often is not known
LimitedSmall studies found paroxetine raised metoprolol blood levels 3 to 5 times and lowered heart rate and blood pressure further. Observational results conflict.How often is not known
LimitedMixed results: pooled observational studies found no rise in birth defects overall with first-trimester use, and higher odds of heart defects and cleft lip or palate.How often is not known

What people take it for, and what was found

Shown to help6

Strong

Heart failure with reduced pumping function

Shown to lower deaths by about a third in heart failure with reduced pumping function, with no difference found between individual beta-blockers.

The numbers and sources

Effect: A network meta-analysis of 21 trials found beta-blockers lowered mortality against placebo or standard treatment after a median 12 months (OR 0.69, 95% credible interval 0.56 to 0.80), with no clear difference between individual drugs [1]. In individual data from 11 trials, beta-blockers lowered all-cause and cardiovascular mortality in people in sinus rhythm across ejection fraction groups, except in the small group at 50% or above [2]. In the three largest trials, deaths were 11.8% against 17.3% on bisoprolol (HR 0.66, 95% CI 0.54 to 0.81) [3], 7.2% against 11.0% per patient-year on extended-release metoprolol (RR 0.66, 95% CI 0.53 to 0.81) [4], and 130 against 190 on carvedilol, a 35% lower risk (95% CI 19 to 48) [5].
Population: 21 trials of six beta-blockers [1]; 14,262 people in sinus rhythm with a median ejection fraction of 27% [2]; 2,647 people with ejection fraction of 35% or less [3]; 3,991 people with ejection fraction of 40% or less [4]; 2,289 people with ejection fraction below 25% [5].
Sources: [1], [2], [3], [4], [5]
Caveats: All three large trials were stopped early for benefit. In people with heart failure and atrial fibrillation, beta-blockers did not improve prognosis [2].

Strong

Lowering blood pressure

Shown to lower blood pressure by about 10/8 mm Hg and heart rate by 11 beats a minute in adults with mild to moderate high blood pressure.

The numbers and sources

Effect: Across 56 trials of beta-1 selective blockers, blood pressure fell by an average of 10/8 mm Hg and heart rate by 11 beats a minute. The largest blood pressure effect came at twice the starting dose, with no graded dose-response for blood pressure across the usual dose range [10]. An analysis of 354 trials found beta-blockers lowered blood pressure by about the same amount as the other main drug classes, on average 9.1/5.5 mm Hg at standard dose [11].
Population: 7,812 people with primary hypertension in 56 trials of eight beta-1 selective blockers [10]; about 40,000 treated and 16,000 placebo participants in 354 trials [11].
Sources: [10], [11]
Caveats: The Cochrane review covers beta-1 selective drugs such as atenolol, metoprolol and bisoprolol, not propranolol or carvedilol [10].

Limited

Heart rate control in atrial fibrillation

One small crossover trial found metoprolol and carvedilol lowered 24-hour heart rate in permanent atrial fibrillation, from 96 beats a minute to 82 and 84.

The numbers and sources

Effect: Mean 24-hour heart rate was 96 beats a minute untreated, 82 on metoprolol 100 mg a day and 84 on carvedilol 25 mg a day, against 75 on diltiazem 360 mg and 81 on verapamil 240 mg [14].
Population: 60 adults with permanent atrial fibrillation, mean age 71, given each drug for 3 weeks in random order [14].
Sources: [14]
Caveats: One small investigator-blind trial of 3-week periods. In people with heart failure and atrial fibrillation, beta-blockers did not improve prognosis in pooled trial data [2].

ModerateVery common

Migraine prevention

Shown to lower episodic migraine by about 1.5 headaches a month on propranolol against placebo, with 40% against 23% halving their migraine days in one trial.

The numbers and sources

How common: Very common: more than 1 in 10 people.
Effect: Across placebo-controlled trials, propranolol lowered episodic migraine by 1.5 headaches a month at 8 weeks (95% CI -2.3 to -0.65) and made a 50% reduction more likely (RR 1.4, 95% CI 1.1 to 1.7). For chronic migraine the estimate was RR 2.0 (95% CI 1.0 to 4.3) [15]. In a crossover trial, migraine days per 4 weeks were 2.91 on slow-release propranolol 160 mg and 3.53 on placebo, and 40% against 23% had at least a 50% reduction [16].
Population: 108 randomized trials of beta-blockers for headache prevention, 50 placebo-controlled [15]; 72 adults with episodic or chronic migraine [16].
Sources: [15], [16]
Caveats: Most of the evidence is for propranolol. Trials comparing beta-blockers with other preventive drugs were mostly single and underpowered [15].

Limited

Performance anxiety and stage fright

Small trials found propranolol removed physical symptoms of stage fright in musicians and raised performance quality as scored by critics.

The numbers and sources

Effect: In two double-blind trials in musicians, propranolol removed the physical impediments to performance caused by stage fright, including dry mouth, and the quality of performance as judged by experienced music critics improved significantly [17].
Population: 29 musicians in two trials [17].
Sources: [17]
Caveats: Two small trials from 1982, and the abstract gives no effect sizes. Not an FDA-approved use. For diagnosed anxiety disorders, see the next block.

Moderate

Essential tremor

Shown to reduce limb tremor in essential tremor on propranolol, rated Level A in one evidence review and clinically useful in another.

The numbers and sources

Effect: The American Academy of Neurology evidence review kept propranolol at Level A, its highest rating, for limb tremor in essential tremor [20]. A Movement Disorder Society review of 64 studies classed propranolol as clinically useful for limb tremor and found insufficient evidence for voice and head tremor [21]. In a crossover trial, propranolol 40 mg three times a day reduced tremor on all measures at day 15, and placebo produced no significant change on accelerometry [22]. The propranolol tablet label lists essential tremor as an approved use and describes a 2-week placebo-controlled study in 9 people [23].
Population: Clinical trials in essential tremor reviewed by two specialist societies [20][21]; 16 people with essential tremor [22].
Sources: [20], [21], [22], [23]
Caveats: The abstracts give no pooled effect size. The evidence is for propranolol.

Mixed results2

Moderate

After a heart attack

Mixed results: older trials found 23% lower odds of death after a heart attack, and three recent trials in people with preserved heart function disagreed.

The numbers and sources

Effect: In a review of older trials, long-term beta-blockers lowered the odds of death by 23% (95% CI 15 to 31), with 42 people treated for 2 years to avoid one death. Short-term trials found a 4% reduction that was not significant [6]. In people with ejection fraction of 50% or more, death or a new heart attack occurred in 7.9% on a beta-blocker and 8.3% without (HR 0.96, 95% CI 0.79 to 1.16) [7]. In people with ejection fraction above 40%, death, reinfarction or heart failure hospitalization occurred at 22.5 against 21.7 events per 1,000 patient-years (HR 1.04, 95% CI 0.89 to 1.22) [8]. In a third trial in people with ejection fraction of 40% or more, death or a major cardiovascular event occurred in 14.2% against 16.3% (HR 0.85, 95% CI 0.75 to 0.98), with fewer new heart attacks (5.0% against 6.7%) [9].
Population: 54,234 people in older randomized trials, mostly of propranolol, timolol and metoprolol [6]; 5,020 people, median 3.5 years [7]; 8,438 people, median 3.7 years [8]; 5,574 people, median 3.5 years [9].
Sources: [6], [7], [8], [9]
Caveats: The older review was published in 1999. The three recent trials were open-label.

Moderate

Heart attack and stroke in high blood pressure

Shown to lower stroke by about 20% against placebo in high blood pressure, with no drop in deaths and more strokes than on other drug classes.

The numbers and sources

Effect: In 13 trials, beta-blockers did not lower all-cause mortality against placebo (RR 0.99, 95% CI 0.88 to 1.11). Total cardiovascular disease fell (RR 0.88, 95% CI 0.79 to 0.97), reflecting fewer strokes (RR 0.80, 95% CI 0.66 to 0.96), with no difference in coronary heart disease (RR 0.93, 95% CI 0.81 to 1.07). Stroke was more frequent than on calcium channel blockers (RR 1.24, 95% CI 1.11 to 1.40) or renin-angiotensin drugs (RR 1.30, 95% CI 1.11 to 1.53) [12]. For atenolol, 4 placebo-controlled trials found no difference in all-cause mortality (RR 1.01, 95% CI 0.89 to 1.15) or heart attack (RR 0.99, 95% CI 0.83 to 1.19), and 5 trials against other drugs found higher mortality on atenolol (RR 1.13, 95% CI 1.02 to 1.25) [13].
Population: 13 trials, with 23,613 people in placebo comparisons and 40,245 people on beta-blockers overall, three quarters of them on atenolol [12]; 6,825 people in 4 placebo-controlled atenolol trials and 17,671 in 5 comparative trials, mean 4.6 years [13].
Sources: [12], [13]
Caveats: Most of the evidence is for atenolol. The Cochrane authors rated most trials at high risk of bias and found no outcome trials of newer vasodilating beta-blockers [12].

Not shown to help1

Moderate

Anxiety disorders

Not shown to reduce anxiety symptoms in social phobia or panic disorder against placebo, in two systematic reviews of small trials.

The numbers and sources

Effect: A 2025 systematic review found no evidence of a benefit of beta-blockers against placebo or benzodiazepines in social phobia or panic disorder, with all pooled comparisons non-significant (p of 0.54 or higher) [18]. A 2016 review of propranolol found no significant difference from benzodiazepines in short-term treatment of panic disorder, and no effect on symptoms of post-traumatic stress disorder [19].
Population: 10 studies, 5 pooled with 179 participants [18]; 8 trials in panic disorder (130 people), specific phobia (37), social phobia (16) and post-traumatic stress disorder (19) [19].
Sources: [18], [19]
Caveats: Small trials with missing data and high or unclear risk of bias [18]. Performance anxiety outside a diagnosed disorder is covered in the block above.

Doses studied

The heart failure trials titrated upward from low doses: extended-release metoprolol from 12.5 or 25 mg toward 200 mg once daily [4], with a mean dose of 159 mg [24], and bisoprolol from 1.25 mg toward 10 mg a day [3]. The carvedilol label reports heart failure trials at up to 50 mg and up to 100 mg a day [25].

The migraine crossover trial used slow-release propranolol 160 mg a day [16], and the tremor trial used propranolol 40 mg three times a day [22]. The atrial fibrillation trial used metoprolol 100 mg and carvedilol 25 mg a day [14]. The surgery trial started extended-release metoprolol 100 mg 2 to 4 hours before surgery and continued 200 mg a day for 30 days [24].

Risks

Reported risks11

ModerateVery common

Fatigue

Shown to raise reported fatigue slightly, by 18 per 1,000 people a year, or one extra report for every 57 people treated.

The numbers and sources

How common: Very common: more than 1 in 10 people.
Effect: Across 15 placebo-controlled trials, beta-blockers were associated with 18 more reports of fatigue per 1,000 people a year (95% CI 5 to 30), one extra report for every 57 people treated for a year. The excess was larger with early-generation beta-blockers [28]. In US heart failure trials of carvedilol, fatigue was reported by 24% against 22% on placebo [25].
Population: More than 35,000 people in 15 trials in heart attack, heart failure or hypertension, each with at least 100 people and 6 months of follow-up [28]; 765 people on carvedilol and 437 on placebo [25].
Sources: [28], [25]
Caveats: Fatigue was frequent on placebo too, so most reports on the drug were not caused by it.

ModerateVery common

Airway narrowing in asthma and COPD

Shown to lower lung function in asthma, with a fall of 20% or more in about 1 in 8 people after a single selective beta-blocker dose.

The numbers and sources

How common: Very common: more than 1 in 10 people.
Effect: In blinded placebo-controlled trials in asthma, a single dose of a selective beta-blocker lowered FEV1 by 6.9% (95% CI 5.2 to 8.5) and caused a fall of 20% or more in 1 in 8 people. Nonselective beta-blockers lowered FEV1 by 10.2% and caused such a fall in 1 in 9 [29]. In COPD, a Cochrane review found cardioselective beta-blockers produced no change in FEV1 or respiratory symptoms against placebo [30]. In a later COPD trial, metoprolol did not change time to first exacerbation (HR 1.05, 95% CI 0.84 to 1.32) and was associated with more exacerbations leading to hospitalization (HR 1.91, 95% CI 1.29 to 2.83), with 11 deaths against 5 on placebo [31].
Population: People with asthma in randomized trials of single doses [29]; 20 studies in COPD, 11 single-dose and 9 lasting 2 days to 12 weeks [30]; 532 people with COPD at raised risk of exacerbations [31].
Sources: [29], [30], [31]
Caveats: The asthma figures are for single doses in trials, symptoms did not rise significantly, and the abstract gives no placebo rate for the fall in lung function [29]. The COPD trial enrolled people with no other reason to take a beta-blocker [31].

ModerateCommon

Slow heart rate and low blood pressure

Shown to raise slow heart rate and low blood pressure, with a slow heart rate in 9% on carvedilol against 1% on placebo in heart failure trials.

The numbers and sources

How common: Common: between 1 in 100 and 1 in 10 people.
Effect: In US heart failure trials of carvedilol, a slow heart rate occurred in 9% against 1% on placebo and low blood pressure in 9% against 3%. In severe heart failure the figures were 10% against 3% and 14% against 8% [25]. In the MERIT-HF trial of extended-release metoprolol, a slow heart rate was reported in 1.5% against 0.4% and dizziness or vertigo in 1.8% against 1.0% [24]. After a heart attack, hospitalization for slow heart rate, heart block, low blood pressure, fainting or pacemaker implantation occurred in 3.4% on a beta-blocker and 3.2% without [7].
Population: 765 people on carvedilol and 437 on placebo in mild to moderate heart failure, and 1,156 against 1,133 in severe heart failure [25]; 1,990 people on metoprolol and 2,001 on placebo [24]; 5,020 people after a heart attack [7].
Sources: [25], [24], [7]
Caveats: Rates differ widely by drug and condition, from 1.5% to 10% for a slow heart rate.

ModerateCommon

New type 2 diabetes

Shown to raise new diabetes by 22% against other non-diuretic blood pressure drugs in people treated for high blood pressure.

The numbers and sources

How common: Common: between 1 in 100 and 1 in 10 people.
Effect: In 12 trials of beta-blockers as first-line treatment for hypertension, new diabetes was 22% more frequent than on non-diuretic drugs (RR 1.22, 95% CI 1.12 to 1.33) [32]. In a network meta-analysis of 22 trials, diabetes developed in 7.57% of people started on a beta-blocker and 6.81% of those on placebo. Against a diuretic, the odds on a beta-blocker did not differ significantly (OR 0.90, 95% CI 0.75 to 1.09) [33].
Population: 94,492 people with hypertension in 12 trials of at least 1 year [32]; 143,153 people without diabetes at entry in 22 trials [33].
Sources: [32], [33]
Caveats: The comparison in [32] is with other drugs, not placebo. The two percentages in [33] are pooled across different trials.

LimitedCommon

Around non-cardiac surgery

One trial found metoprolol started just before non-cardiac surgery lowered heart attacks and raised deaths, 3.1% against 2.3%, and strokes, 1.0% against 0.5%.

The numbers and sources

How common: Common: between 1 in 100 and 1 in 10 people.
Effect: Extended-release metoprolol started 2 to 4 hours before surgery and continued 30 days lowered heart attack (4.2% against 5.7% on placebo, HR 0.73) and raised death (3.1% against 2.3%, HR 1.33, 95% CI 1.03 to 1.74) and stroke (1.0% against 0.5%, HR 2.17, 95% CI 1.26 to 3.74) [35]. A slow heart rate (6.6% against 2.4%) and low blood pressure (15% against 9.7%) were more frequent [24].
Population: 8,351 people with or at risk of atherosclerotic disease having non-cardiac surgery who were not already taking a beta-blocker [35].
Sources: [35], [24]
Caveats: One trial, of people newly started on a beta-blocker hours before surgery. It does not describe people already taking one.
Why limited: This rests on one trial, of 8,351 people. Strength counts independent studies that agree, so one trial is limited at any size.

LimitedHow often is not known

Stopping suddenly

The label warns that worse angina and, in some cases, heart attack have followed abrupt stopping of beta-blockers.

The numbers and sources

How common: How often is not known: the sources give no rate.
Effect: The metoprolol label states that after abrupt cessation of certain beta-blockers, exacerbations of angina and, in some cases, heart attack have occurred, particularly in people with ischemic heart disease [24]. The atenolol label reports severe exacerbation of angina, heart attack and ventricular arrhythmias after abrupt discontinuation in people with angina [26]. The propranolol and carvedilol labels carry the same warning [27][25]. The metoprolol label also states that abrupt withdrawal in thyrotoxicosis might precipitate a thyroid storm [24].
Population: People with coronary artery disease taking beta-blockers, as described in the labels [24][26].
Sources: [24], [26], [27], [25]
Caveats: Based on reports, with no rate. The atenolol label sets the statement apart in a box, and the other labels list it under warnings.

ModerateHow often is not known

Sexual dysfunction

Shown to raise reported sexual dysfunction slightly, by 5 per 1,000 people a year, or one extra report for every 199 people treated.

The numbers and sources

How common: How often is not known: the sources give no rate.
Effect: Across placebo-controlled trials, beta-blockers were associated with 5 more reports of sexual dysfunction per 1,000 people a year (95% CI 2 to 8), one extra report for every 199 people treated for a year. The risk did not differ by lipid solubility of the drug [28].
Population: More than 35,000 people in 15 trials in heart attack, heart failure or hypertension [28].
Sources: [28]
Caveats: The abstract gives the excess over placebo, not the rate in each group, so no band can be read from it.

ModerateHow often is not known

Weight gain

Shown to raise body weight by a median 1.2 kg against controls in 8 trials, with the gain in the first few months.

The numbers and sources

How common: How often is not known: the sources give no rate.
Effect: In 8 randomized trials lasting at least 6 months, body weight at the end was higher in the beta-blocker group than in controls, by a median 1.2 kg (range -0.4 to 3.5 kg). The gain came in the first few months, with no further gain against controls after that [34].
Population: People in 8 randomized controlled trials of beta-blockers for hypertension lasting 6 months or more [34].
Sources: [34]
Caveats: A systematic analysis from 2001 with no pooled confidence interval, and no count of how many people gained weight.

LimitedHow often is not known

Masked low blood sugar with diabetes medication

The label warns that beta-blockers may hide early signs of low blood sugar, such as a fast heartbeat, and may add to the effect of insulin.

The numbers and sources

How common: How often is not known: the sources give no rate.
Effect: The carvedilol label states that beta-blockers may prevent early warning signs of hypoglycemia such as a fast heart rate, and may raise the risk of severe or prolonged hypoglycemia, especially in people with diabetes, children and people who are fasting. It also states that beta-blockers may enhance the blood-sugar-lowering effect of insulin and oral diabetes drugs [25].
Population: People taking carvedilol, as described in the label [25].
Sources: [25]
Caveats: The label gives no rate.

LimitedHow often is not known

With verapamil, diltiazem, digoxin or clonidine

The label warns that these drugs slow the heart and that taking them with a beta-blocker can raise the risk of a slow heart rate.

The numbers and sources

How common: How often is not known: the sources give no rate.
Effect: The metoprolol label states that digitalis glycosides, clonidine, diltiazem and verapamil slow conduction and heart rate, and that use with beta-blockers can increase the risk of a slow heart rate. It also states that beta-blockers may exacerbate the rebound high blood pressure that can follow withdrawal of clonidine [24].
Population: People taking metoprolol with these drugs, as described in the label [24].
Sources: [24]
Caveats: The label gives no rate.

LimitedHow often is not known

With paroxetine or fluoxetine

Small studies found paroxetine raised metoprolol blood levels 3 to 5 times and lowered heart rate and blood pressure further. Observational results conflict.

The numbers and sources

How common: How often is not known: the sources give no rate.
Effect: In a systematic review of 9 reports, experimental studies found paroxetine raised metoprolol exposure 3 to 5 times and significantly lowered systolic blood pressure and heart rate. Case reports described a slow heart rate and heart block. One cohort study linked the combination to early stopping of metoprolol, and one case-control study found no significant link to a slow heart rate [36]. The metoprolol label states that strong CYP2D6 inhibitors such as quinidine, fluoxetine, paroxetine and propafenone doubled metoprolol concentrations [24].
Population: 4 experimental studies, 2 observational studies and 3 case reports [36].
Sources: [36], [24]
Caveats: The evidence is for metoprolol. The experimental studies were small and no rate of harm is available.

Mixed results1

LimitedHow often is not known

Use in pregnancy

Mixed results: pooled observational studies found no rise in birth defects overall with first-trimester use, and higher odds of heart defects and cleft lip or palate.

The numbers and sources

How common: How often is not known: the sources give no rate.
Effect: In 13 observational studies, first-trimester use of oral beta-blockers showed no increased odds of all or major congenital anomalies. Organ-specific analyses found higher odds of cardiovascular defects (OR 2.01, 95% CI 1.18 to 3.42, 4 studies), cleft lip or palate (OR 3.11, 95% CI 1.79 to 5.43, 2 studies) and neural tube defects (OR 3.56, 95% CI 1.19 to 10.67, 2 studies) [37]. The metoprolol label states that published observational studies have not demonstrated a drug-associated risk of major birth defects or miscarriage, and that reports of growth restriction, preterm birth and perinatal death with beta-blocker use are inconsistent [24].
Population: 13 population-based case-control or cohort studies [37].
Sources: [37], [24]
Caveats: The authors called causality difficult to interpret, given few and heterogeneous studies and possible bias [37].

Checked, no increase found1

Moderate

Depression

Not shown to raise reported depressive symptoms against placebo across 15 trials in more than 35,000 people.

The numbers and sources

How common: How often is not known: the sources give no rate.
Effect: Beta-blockers were not associated with a significant increase in reported depressive symptoms, at 6 more reports per 1,000 people a year with an interval from 7 fewer to 19 more. The result did not differ by lipid solubility of the drug [28].
Population: More than 35,000 people in 15 placebo-controlled trials in heart attack, heart failure or hypertension [28].
Sources: [28]
Caveats: One meta-analysis, of trials not designed to measure mood. The abstract gives no rate in each group.

Claims tested and not found

That beta-blockers cause depression. Across 15 placebo-controlled trials with more than 35,000 people, reported depressive symptoms did not rise significantly (6 per 1,000 a year, 95% CI -7 to 19) [28].
That beta-blockers stop fitness gains from training. In 39 healthy men randomized to propranolol, atenolol or placebo during supervised training, peak oxygen consumption rose in all three groups and the size of the change did not differ between them [38].
That beta-blockers lower deaths in people with heart failure and atrial fibrillation. In 3,050 people in atrial fibrillation at baseline, beta-blockers raised ejection fraction and did not improve prognosis [2].
That atenolol lowers deaths or heart attacks in high blood pressure. In 4 placebo-controlled trials with 6,825 people, all-cause mortality (RR 1.01) and heart attack (RR 0.99) did not differ from placebo [13].
That propranolol treats anxiety disorders. Two systematic reviews found no significant benefit in social phobia or panic disorder [18][19].

Sources

Chatterjee S, Biondi-Zoccai G, Abbate A, et al. Benefits of β blockers in patients with heart failure and reduced ejection fraction: network meta-analysis. BMJ. 2013. https://doi.org/10.1136/bmj.f55
Cleland JGF, Bunting KV, Flather MD, et al. Beta-blockers for heart failure with reduced, mid-range, and preserved ejection fraction: an individual patient-level analysis of double-blind randomized trials. European Heart Journal. 2018. https://doi.org/10.1093/eurheartj/ehx564
CIBIS-II Investigators and Committees. The Cardiac Insufficiency Bisoprolol Study II (CIBIS-II): a randomised trial. The Lancet. 1999. https://doi.org/10.1016/S0140-6736(98)11181-9
MERIT-HF Study Group. Effect of metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL Randomised Intervention Trial in Congestive Heart Failure (MERIT-HF). The Lancet. 1999. https://doi.org/10.1016/S0140-6736(99)04440-2
Packer M, Coats AJ, Fowler MB, et al. Effect of carvedilol on survival in severe chronic heart failure. New England Journal of Medicine. 2001. https://doi.org/10.1056/NEJM200105313442201
Freemantle N, Cleland J, Young P, Mason J, Harrison J. beta Blockade after myocardial infarction: systematic review and meta regression analysis. BMJ. 1999. https://doi.org/10.1136/bmj.318.7200.1730
Yndigegn T, Lindahl B, Mars K, et al. Beta-Blockers after Myocardial Infarction and Preserved Ejection Fraction. New England Journal of Medicine. 2024. https://doi.org/10.1056/NEJMoa2401479
Ibanez B, Latini R, Rossello X, et al. Beta-Blockers after Myocardial Infarction without Reduced Ejection Fraction. New England Journal of Medicine. 2025. https://doi.org/10.1056/NEJMoa2504735
Munkhaugen J, Kristensen AMD, Halvorsen S, et al. Beta-Blockers after Myocardial Infarction in Patients without Heart Failure. New England Journal of Medicine. 2025. https://doi.org/10.1056/NEJMoa2505985
Wong GW, Boyda HN, Wright JM. Blood pressure lowering efficacy of beta-1 selective beta blockers for primary hypertension. Cochrane Database of Systematic Reviews. 2016. https://doi.org/10.1002/14651858.CD007451.pub2
Law MR, Wald NJ, Morris JK, Jordan RE. Value of low dose combination treatment with blood pressure lowering drugs: analysis of 354 randomised trials. BMJ. 2003. https://doi.org/10.1136/bmj.326.7404.1427
Wiysonge CS, Bradley HA, Volmink J, Mayosi BM, Opie LH. Beta-blockers for hypertension. Cochrane Database of Systematic Reviews. 2017. https://doi.org/10.1002/14651858.CD002003.pub5
Carlberg B, Samuelsson O, Lindholm LH. Atenolol in hypertension: is it a wise choice? The Lancet. 2004. https://doi.org/10.1016/S0140-6736(04)17355-8
Ulimoen SR, Enger S, Carlson J, et al. Comparison of four single-drug regimens on ventricular rate and arrhythmia-related symptoms in patients with permanent atrial fibrillation. The American Journal of Cardiology. 2013. https://doi.org/10.1016/j.amjcard.2012.09.020
Jackson JL, Kuriyama A, Kuwatsuka Y, et al. Beta-blockers for the prevention of headache in adults, a systematic review and meta-analysis. PLoS One. 2019. https://doi.org/10.1371/journal.pone.0212785
Stovner LJ, Linde M, Gravdahl GB, et al. A comparative study of candesartan versus propranolol for migraine prophylaxis: A randomised, triple-blind, placebo-controlled, double cross-over study. Cephalalgia. 2014. https://doi.org/10.1177/0333102413515348
Brantigan CO, Brantigan TA, Joseph N. Effect of beta blockade and beta stimulation on stage fright. The American Journal of Medicine. 1982. https://doi.org/10.1016/0002-9343(82)90592-7
Archer C, Wiles N, Kessler D, Turner K, Caldwell DM. Beta-blockers for the treatment of anxiety disorders: A systematic review and meta-analysis. Journal of Affective Disorders. 2025. https://doi.org/10.1016/j.jad.2024.09.068
Steenen SA, van Wijk AJ, van der Heijden GJ, et al. Propranolol for the treatment of anxiety disorders: Systematic review and meta-analysis. Journal of Psychopharmacology. 2016. https://doi.org/10.1177/0269881115612236
Zesiewicz TA, Elble RJ, Louis ED, et al. Evidence-based guideline update: treatment of essential tremor: report of the Quality Standards subcommittee of the American Academy of Neurology. Neurology. 2011. https://doi.org/10.1212/WNL.0b013e318236f0fd
Ferreira JJ, Mestre TA, Lyons KE, et al. MDS evidence-based review of treatments for essential tremor. Movement Disorders. 2019. https://doi.org/10.1002/mds.27700
Gironell A, Kulisevsky J, Barbanoj M, et al. A randomized placebo-controlled comparative trial of gabapentin and propranolol in essential tremor. Archives of Neurology. 1999. https://doi.org/10.1001/archneur.56.4.475
Propranolol hydrochloride tablets (Par), prescribing information. DailyMed, US National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=0d74bb04-8227-4afa-b523-ce1556150e07
Toprol-XL (metoprolol succinate) extended-release tablets, prescribing information. DailyMed, US National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=496ddfaa-7c9c-4888-b747-a210249b367a
Coreg (carvedilol) tablets, prescribing information. DailyMed, US National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=07c619c6-4a0c-445e-94fa-664a54f68a39
Tenormin (atenolol) tablets, prescribing information. DailyMed, US National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=6e850b1e-28a4-4ff8-8ed7-bb0b29faa28a
Inderal LA (propranolol hydrochloride) extended-release capsules, prescribing information. DailyMed, US National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=35d28979-36b1-4630-b85e-a44e0a443734
Ko DT, Hebert PR, Coffey CS, et al. Beta-blocker therapy and symptoms of depression, fatigue, and sexual dysfunction. JAMA. 2002. https://doi.org/10.1001/jama.288.3.351
Morales DR, Jackson C, Lipworth BJ, et al. Adverse respiratory effect of acute β-blocker exposure in asthma: a systematic review and meta-analysis of randomized controlled trials. Chest. 2014. https://doi.org/10.1378/chest.13-1235
Salpeter S, Ormiston T, Salpeter E. Cardioselective beta-blockers for chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews. 2005. https://doi.org/10.1002/14651858.CD003566.pub2
Dransfield MT, Voelker H, Bhatt SP, et al. Metoprolol for the Prevention of Acute Exacerbations of COPD. New England Journal of Medicine. 2019. https://doi.org/10.1056/NEJMoa1908142
Bangalore S, Parkar S, Grossman E, Messerli FH. A meta-analysis of 94,492 patients with hypertension treated with beta blockers to determine the risk of new-onset diabetes mellitus. The American Journal of Cardiology. 2007. https://doi.org/10.1016/j.amjcard.2007.05.057
Elliott WJ, Meyer PM. Incident diabetes in clinical trials of antihypertensive drugs: a network meta-analysis. The Lancet. 2007. https://doi.org/10.1016/S0140-6736(07)60108-1
Sharma AM, Pischon T, Hardt S, Kunz I, Luft FC. Hypothesis: Beta-adrenergic receptor blockers and weight gain: A systematic analysis. Hypertension. 2001. https://doi.org/10.1161/01.HYP.37.2.250
POISE Study Group, Devereaux PJ, Yang H, et al. Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial. The Lancet. 2008. https://doi.org/10.1016/S0140-6736(08)60601-7
Bahar MA, Kamp J, Borgsteede SD, Hak E, Wilffert B. The impact of CYP2D6 mediated drug-drug interaction: a systematic review on a combination of metoprolol and paroxetine/fluoxetine. British Journal of Clinical Pharmacology. 2018. https://doi.org/10.1111/bcp.13741
Yakoob MY, Bateman BT, Ho E, et al. The risk of congenital malformations associated with exposure to β-blockers early in pregnancy: a meta-analysis. Hypertension. 2013. https://doi.org/10.1161/HYPERTENSIONAHA.111.00833
Savin WM, Gordon EP, Kaplan SM, et al. Exercise training during long-term beta-blockade treatment in healthy subjects. The American Journal of Cardiology. 1985. https://doi.org/10.1016/0002-9149(85)91063-X

Everything in the library