#22

I think it’s important to differentiate between something that is providing a medical outcome (i.e., mgmt of HTN) vs something that may have wider applicability through a longevity “stack” (the world at large would benefit from a lower bp but at the healthy individual level, I’m not too sure.

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#23

I’d be curious to see a data sample of users who had HBP and a normal HR, considering 70% of Americans will experience HBP at some point in their lives.

Many Americans Wrongly Assume They Understand What Normal Blood Pressure Is – and That False Confidence Can Be Deadly – USC Schaeffer.

#24

The study below says, that in the elderly, there is an increased risk of stroke with the use of beta blockers.

The lack of effectiveness at lowering central blood pressure may be exacerbated in patients with elevated PWV (pulse wave velocities) [[23] Heart Rate and Blood Pressure: Any Possible Implications for Management of Hypertension? - PMC)]. This interaction may explain the increased risk for stroke associated with beta-blockers in the elderly, a group with elevated PWV, and the opposite effect in younger subjects with normal PWV

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#25

Unfortunately the studies I’ve seen that highlight potential negatives of “beta blockers” do not even consider that nebivolol has unique effects that may exclude it, specifically its vasodilating properties, as in the following study which shows it reduces central aortic pressure and stiffness:

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#26

Correct, Nebivolol is a highly selective Beta Blocker acting almost exclusively on receptors in the heart.

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#27

Not just the heart, but the peripheral vasculature as well (vasodilating effects via nitric oxide) and as a beta 3 agonist, other potential non-vascular benefits as well.

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#28

Yes, and the side effects that are often stated with other beta blockers like worse stamina and erectile dysfunction do not happen with Nebivolol

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#29

I take Ramipril to lower blood pressure and have recently added the beta blocker propranolol in order to lower my resting heart rate. Despite doing regular cardio since I was a teenager (I’m now 65) and following a routine of Zone 2 cardio for 45 min x 3 times a week and Zone 5 HIIT for 10 min x 3 times a week, my resting heart rate was high at 70 to 80 BPM. My Oura ring showed a low sleeping heart rate in the high 60s. When I meditate with deep breathing, my heart rate goes up typically 10 BPM. The propranolol has lowered my RHR to about 10 BPM. I have a mild essential tremor in my left hand and propranolol is on-label treatment for that so I could get a prescription. I haven’t noticed a decrease in exercise performance since taking it. My HIIT workout involves sprinting up stairs and my heart rate goes to 160 BPM when I do that. Propranolol is used as part of desensitization therapy for phobias and a PED for athletes involved in sports that require a steady hand such as archery. Although Nebivolol than propranolol sounds like it might be a better options. Any thoughts?

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#30

What is your propranolol dose?

#31

20 mg morning, 20 mg lunch, 40 mg before bed

#32

I take it occasionally for headache prophylaxis, 40-80mg, but it decreases my max. heart rate significantly. I read some studies that lactate output and muscle benefit is same as without but still makes me wonder if CV benefits are diminished, since my max heart rate drops around 20 bpm.
Otherwise I really like propranolol, the effect it has on nervous system, helps if stressed and with anxiety too. I also noticed that it drops significantly my BP.

#33

Max heart rate (MHR) is apparently not an indication of fitness. MHR is predominantly genetically determined and does not increase as your fitness level raises. Although the length of time you can sustain your MHR does increase with fitness. And although beta-blockers reduce MHR, and this might impact the performance of elite athletes, Harvard Health says “your beta blocker won’t prevent you from getting the positive effects of exercise. You will still build muscle, keep your bones strong, and lower your cholesterol and blood sugar levels. You’ll also improve your heart’s efficiency and endurance.”

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#34

The Impact of beta blockade on the cardio-respiratory system and symptoms during exercise - PMC.

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#35

Carvedilol vs nebivolol: which one is best?

In the ITP, nebivolol “was also found to produce a female-specific decline (4%, p = 0.03) in lifespan”. In males, there was also a borderline significant lifespan shortening. (poke @LukeMV) The ITP used 60 ppm, so 10 mg/kg body weight/day, so about 1 mg/kg for a human? That’s a lot! A previous study that used a lower dose (1 mg/kg body weight/day, for about 0.1 mg/kg for a human close to the average daily dose of 5 mg/day) found that: “The β-blockers metoprolol and nebivolol, administered in food daily beginning at 12 months of age, significantly increase the mean and median life span of isocalorically fed, male C3B6F1 mice, by 10 and 6.4 %, respectively (P < 0.05).” (β1-Adrenergic receptor blockade extends the life span of Drosophila and long-lived mice 2013) For metoprolol they used 30 mg/kg body weight/day, which is also close to the daily human dose (150 mg/day). So if you trust this earlier study, metoprolol is better than nebivolol at the normal human doses.

On the other hand, carvedilol led to a +25% but NOT statistically significant lifespan increase in the Ora Biomedical challenge. It worked wonders in early age but then had a detrimental effect:

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(I think resting heart rate starts decreasing from age ~60, so maybe carvedilol shouldn’t be used in healthy people past that age? Or maybe it should only be used to reach a given resting heart rate threshold?)

Metoprolol was tested but at a dose probably too low, so nothing happened:

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According to Meta-Analysis of Carvedilol Versus Beta 1 Selective Beta-Blockers (Atenolol, Bisoprolol, Metoprolol, and Nebivolol) 2013: “Compared to β1-selective BBs used in HF (8 trials, n = 4,563), carvedilol significantly reduced all-cause mortality (risk ratio 0.85, 95% confidence interval 0.78 to 0.93, p = 0.0006). In 3 trials of patients with AMI (n = 644), carvedilol significantly reduced all-cause mortality by 45% (fixed-effects model: risk ratio 0.55, 95% confidence interval 0.32 to 0.94, p = 0.03, random-effects model: risk ratio 0.56, 95% confidence interval 0.26 to 1.12, p = 0.10), with no reduction in non-fatal MI (risk ratio 0.61, 95% confidence interval 0.31 to 1.22, p = 0.16). In conclusion, carvedilol, as compared against atenolol, bisoprolol, metoprolol and nebivolol in randomized direct comparison trials, significantly reduced all-cause mortality in systolic HF patients.”

One reason given to use nebivolol compared to other beta-blockers is the potential beneficial effect on erectile function. However, according to this paper (Effects of major antihypertensive drug classes on erectile function: a network meta-analysis 2022), although nebivolol might be better than non-vasodilatory beta-blockers (such as bisoprolol and metoprolol), there’s no difference between nebivolol and other vaso-dilatory beta-blockers (carvedilol and labetalol) in terms of erectile function.

Nebivolol is still the only beta-blocker that can increase nitric oxide. And carvedilol has a shorter half-life so it’s taken twice daily. Some countries have carvedilol SR, once daily. So there’s a tradeoff…

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What Are the Optimal BP Medication Combo for You & Why?
#36

Great information.

So the ITP used ridiculously high dosages of Nebivolol that a human would never take, which doesn’t make sense to me. What is the point of that? The older rat study and worm studies you mentioned seem to have more credibility since the correct dosages were used.

Combine that with the fact that mice and worms don’t die from heart related problems, which beta blockers are used for. Therefore, I am not sure how much merit I will put into non human studies when it comes to beta blockers.

Cardevilol vs Metoprolol vs Nebivolol remains an interesting debate.

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#37

Yes, on this see also this post: Rilmenidine vs Telmisartan or other BP meds for Longevity - #93 by adssx

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