Beta-blockers vs. calcium channel blockers: What’s the difference?

Beta-blockers and calcium channel blockers are two different classes of medicine, often used for the same cardiovascular conditions. Many people take beta-blockers or calcium channel blockers, and some are even prescribed both types of medication simultaneously. Both types of medication can lower blood pressure and may also be prescribed for the treatment and prevention of other health conditions, but they work in different ways.

Beta-blockers, also known as beta-adrenergic blockers, are a class of medication used to treat and prevent a host of health conditions, including but not limited to:

Heart conditions:

• Angina
• Cardiac healing after a heart attack
• Congestive heart failure
• Heart rhythm problems (like atrial fibrillation)
• High blood pressure
• Hypertrophic cardiomyopathy

Additional health conditions:

• Anxiety – social phobias and performance anxiety
• Certain types of tremors
• Glaucoma
• Migraines

Beta-blockers block access to beta-receptors, thereby reducing and preventing various responses throughout the body. One way that beta-blockers work is by blocking the effects of adrenaline on specific beta-receptors in the body, causing the heart to beat more slowly, relaxing blood vessels and reducing blood pressure.

There are beta-receptors on many cells in the body that allow chemical substances to either enhance or inhibit cell activity and processes within the body. These beta-receptors are divided into three categories based on where they are located. Beta-1 receptors are found primarily in the heart and kidneys. Beta-2 receptors can be found on lung and blood vessel cells, though heart cells also have some of these receptors. Beta-3 receptors are found in fat and bladder cells.

There are three types of beta-blockers:

• Nonselective beta-blockers block both beta-1 and beta-2 receptors. These include medications such as propranolol (Inderal), sotalol (Betapace) and nadolol (Corgard). This type of beta-blocker is not recommended for smokers or those with asthma or other lung conditions.
• Cardioselective beta-blockers block the beta-1 receptors in the heart. These medications include atenolol (Tenormin) and metoprolol (Lopressor).
• Third generation beta-blockers block both beta and alpha receptors to relax blood vessels. This group of beta-blockers includes labetalol (Normodyne) and carvedilol (Coreg). Some medications in this group also stimulate the lining of blood vessels to generate nitric oxide, which further helps the blood vessels relax.

Possible side effects of beta-blockers may include:

• Drowsiness and fatigue
• Dry mouth or eyes
• Headache
• Shortness of breath or difficulty breathing
• Tingling or coldness in the hands or feet
• Weakness and dizziness
• Weight gain
• Nausea
• Sexual dysfunction, including erectile dysfunction
• Mild depression
• Trouble sleeping or disturbing dreams
• Constipation

Calcium channel blockers (CCBs), also known as calcium antagonists, are used to treat and prevent a variety of cardiovascular conditions as well as other health conditions, including but not limited to:

• Angina
• Heart rhythm disturbances
• High blood pressure
• Hypertrophic cardiomyopathy
• Migraines
• Pulmonary hypertension
• Raynaud’s disease

Calcium channel blockers work by slowing the entry of calcium into the cells of the heart muscle and blood vessel walls.

There are two types of calcium channel blockers:

• Non-dihydropyridine calcium channel blockers inhibit the sinoatrial (SA) and atrioventricular (AV) nodes in the heart, which control heart rhythm. These medicines are helpful for lowering high blood pressure, reducing the oxygen needs in the heart and slowing rhythm disturbances that make the heart beat faster than normal. Examples of non-dihydropyridine calcium channel blockers include verapamil and diltiazem.
• Dihydropyridine calcium channel blockers help relax the peripheral (noncardiac) blood vessels, so these medicines are recommended for hypertension and migraines. Drugs in this group include amlodipine, nifedipine and nicardipine.

Common side effects of calcium channel blockers may include:

• Constipation
• Dizziness
• Fatigue
• Flushing
• Heartburn
• Nausea
• Numbness or tingling in hands or feet
• Swelling of the abdomen, feet or ankles
• Very fast or very slow heartbeat

Less common side effects include:

• Wheezing, coughing or shortness of breath
• Trouble swallowing
• Bleeding, swollen or tender gums
• Chest pain
• Fainting
• Fever
• Vivid dreams
• Yellowing of the skin or eyes (jaundice)

If you have been prescribed beta-blockers or calcium channel blockers and have developed any of the side effects listed above, be sure to consult with your healthcare provider.

Clinically reviewed and updated by Julie McDaniel, MSN, RN, CRNI, June 2024.