|B1 Selective Blockers||Non-Selective Blockers (B1 and B2)||Mixed Blockers (Beta and alpha)|
|Hydrophilic||acebutolol, atenolol, bisoprolol (both), esmolol||nadolol, pindolol, sotalol|
|Lipophilic||bisoprolol (both), metoprolol, nebivolol||propranolol||carvedilol, labetalol|
- Avoid mixed and non-selective agents in asthma. Alpha blockade causes vasodilation, decreases peripheral resistance, and causes no reflex tachycardia. (acronym: Can Let No Purple People Start)
- Lipophilic agents reduce remodeling and protect against sudden death.
- Patients sometimes feel worse when starting carvedilol. Start low and titrate up.
- Estrogen increases blood pressure
- Labetalol is preferred anti-hypertensive in pregnancy, followed by nifedipine and methyldopa.