America’s Beta-Blocker Habit: Millions Are on a Drug They May Not Need

New research questions the routine prescription of beta-blockers after heart attacks and for high blood pressure, but prescribing habits are slow to change.

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Blair Tindall, Grammy-nominated oboist and author of “Mozart in the Jungle,” once admitted that she couldn’t get through an audition without help. Her hands shook, her heart raced—until a fellow musician gave her a beta-blocker. Suddenly, she could play.

Tindall died of cardiovascular disease in 2023 at age 63. The drug she credited with saving her career is now one of the most common U.S. prescriptions. In 2023, U.S. pharmacies dispensed about 60 million metoprolol prescriptions and 10 million propranolol prescriptions, making them two of the most common beta-blockers in use. Familiarity has made beta-blockers feel safe, even ordinary.

However, the evidence of its effects is shifting. For people with weak hearts, beta-blockers are still lifesaving, improving survival and even reversing harmful changes in heart structure. For others, the benefits are less clear. Recent trials show little advantage for heart attack survivors with normal heart function, and one large study shows possible harm in women—especially those whose hearts were still pumping normally—although more research is needed.

Meanwhile, the practice of prescribing them for anxiety and performance anxiety is growing, despite thin data to support their efficacy and some serious side effects.

The question isn’t whether beta-blockers work, but when—and for whom.

Where They Save Lives

Beta-blockers are lifesaving for certain patients. They arrived in the 1960s and quickly became a reflex prescription after heart attacks and for high blood pressure. By blocking adrenaline, they slow the heart rate and reduce its oxygen demand.

Today, more than 26 million Americans take beta-blockers each year, with more than 100 million prescriptions for drugs such as metoprolol, carvedilol, propranolol, and atenolol filled.

For some patients, trust in the drugs is well-placed. In those with weakened hearts, a condition doctors call heart failure with reduced ejection fraction, the drugs are essential.

A 2021 review confirmed that they not only improve survival but can also reverse harmful changes in heart structure and function. They are also widely used for abnormal rhythms such as atrial fibrillation and ventricular tachycardia, in which slowing the heart can prevent dangerous complications.

Beyond the Heart

What began as routine cardiac care has quietly morphed into something else entirely. Beta-blockers have become a catch-all pill for anxiety, stage fright, jitters, and even headaches.

Propranolol was the first widely used beta-blocker, popular among musicians, actors, athletes, and students hoping to steady their hands or calm a racing pulse. It blunts the body’s adrenaline surge, although it does little for the anxious thoughts behind it.

Propranolol is approved by the Food and Drug Administration (FDA) for migraine prevention, although newer medicines such as calcitonin gene-related peptide inhibitors may be more effective for some patients. Beta-blockers are also prescribed for tremor and symptoms of thyroid disease, while topical forms such as timolol are used for glaucoma. The drug dampens adrenaline’s effects, calming overactive nerves and blood vessels, which explains its use in conditions beyond the heart.

Researchers are testing propranolol for trauma, hoping that it might blunt painful memories. A 2025 analysis found modest improvements in post-traumatic stress disorder symptoms, but the evidence is still thin.

Children are increasingly part of this widening circle of beta-blocker users. An FDA review of nearly 90 million pediatric records found that by adolescence, most prescriptions for the drugs weren’t for the heart at all. About one in five were for anxiety and another one-fifth for migraines, far outpacing prescriptions for arrhythmias or congenital disease.

Not all clinicians agree with its off-label use.

“Public speakers aren’t ‘deficient’ in beta-blockers,” Dr. Jack Wolfson, a cardiologist and founder of Natural Heart Doctor, told The Epoch Times. “Using them for anxiety or performance ignores root cause.”

Where the Evidence Weakens

Two large trials—REDUCE-AMI, with 5,020 patients, and REBOOT, with 8,505—found no benefit in keeping heart attack survivors with normal heart function on long-term beta-blockers. For high blood pressure, studies have shown that beta-blockers prevent fewer strokes than newer treatments. Even for atrial fibrillation, for which they remain first-line therapy, newer research suggests that alternatives such as digoxin or calcium channel blockers may be safer.

“There are no long-term safety and efficacy data for beta-blockers in the treatment of atrial fibrillation, and there are several emerging concerns regarding their use,” two cardiologists wrote in EP Europace in 2024, calling for larger trials to compare rate-control strategies head-to-head.

There is also a gender divide. A 2025 study published in the European Heart Journal found that women taking beta-blockers after heart attacks were 45 percent more likely to die, suffer another heart attack, or be hospitalized for heart failure. That excess risk was not seen in men.

Part of the problem may be dosing.

“Beta-blockers can raise blood sugar and deplete certain nutrients, which may affect women differently,” Wolfson said. “We don’t dose them by sex or weight. A man at 180 pounds and a woman at 130 might walk out with the exact same prescription.”

Still, more than 80 percent of heart attack patients leave the hospital with a beta-blocker prescription, and many stay on them for years.

The Costs Patients Don’t Hear About

The side effects patients rarely hear about are real and pervasive. Fatigue, dizziness, and weight gain are common. Many patients report feeling slowed, as if their energy never fully returns. By blocking adrenaline, the drugs mute the body’s natural response to exercise, which comes at a cost for athletes and older adults trying to stay active.

“They can induce things like erectile dysfunction, fatigue, and exercise intolerance—all the things people don’t want,” Dr. Andrew Freeman, director of cardiovascular prevention at National Jewish Health, told The Epoch Times.

Other risks cut deeper. In people with asthma, nonselective beta-blockers such as propranolol can trigger wheezing or dangerous flare-ups. In people with diabetes, they can mask the warning signs of low blood sugar, such as sweating and tremors, leaving patients unaware until the drop becomes severe while potentially pushing blood sugar levels higher by reducing insulin effectiveness.

A 2025 review published in the Hellenic Journal of Cardiology found that beta-blockers can reduce insulin release and raise insulin resistance, nudging some patients toward diabetes.

Even with decades of research, we still don’t know enough about how safe beta-blockers are for everyone over the long haul. The FDA tracks problems through its Adverse Event Reporting System, but that database captures only a fraction of what happens in real life.

On Sept. 11, a search of the database showed nearly 63,000 reports tied to metoprolol, including about 48,000 serious cases and more than 9,400 deaths. Propranolol, the beta-blocker often used for migraines and stage fright, was linked to another 30,000 reports, more than half involving women. Off-label use was the most common entry.

Those are just two drugs in a class that also includes atenolol, carvedilol, and labetalol. Studies suggest that only 6 percent to 10 percent of serious reactions ever get reported, meaning that the actual scope of harm is almost certainly underestimated.

The FDA cautions that such reports do not prove cause and effect. Still, the numbers illustrate that routine medications carry risks.

“The side effects are real,” Wolfson said. “And patients don’t always hear about them.”

For many, the pill in their cabinet is simply “the blood pressure pill.”

Why Doctors Keep Prescribing

Once a drug becomes routine, it rarely fades, sustained by medical inertia, outdated training, and habit.

Doctors are reluctant to disrupt that pattern. In a 2023 survey, nearly one in four admitted to starting beta-blockers without a clear reason, and 40 percent said they rarely take patients off them. Many patients started beta-blockers decades ago and never stopped.

“Physician behavior takes a very long time to change,” Freeman said. “Even when guidelines shift, practice variation is huge. Doctors fall back on how they were trained, and it can take years for new evidence to reach everyday care.”

Cheap generics reinforce the inertia. With no drug company promoting new studies or education campaigns and with patients resistant to dropping a pill they have taken for years, prescriptions persist on autopilot.

“Doctors don’t have the time or the training to look for root causes or to deprescribe,” Wolfson said. “One prescription leads to side effects, which leads to another drug, and another—that cascade is the real problem.”

What Patients Should Do

Freeman cautioned against stopping medications on your own but urged patients to schedule a yearly “medication reconciliation,” a review of what they still need. His favorite clinic days, he said, are those on which patients who have embraced lifestyle changes call to say their blood pressure has dropped too low for pills.

“They lose 20, 30, 50 pounds and ask, ‘Doc, can I get off some of these?’“ he said. ”The answer is, ‘yes.’”

Most doctors aren’t accustomed to deprescribing, so you have to ask, according to Freeman.

“If you don’t have atrial fibrillation, don’t have heart failure, and your blood pressure isn’t wildly out of control, and you’re on a beta-blocker, it’s worth asking, ‘Do I still need this?’” he said.

The alternatives aren’t always pills. Guidelines emphasize diet, exercise, stress management, and sleep, changes that often prove more effective than medications.

“Lifestyle is truly the most effective blood pressure pill,” Freeman said.

Beta-blockers tell a familiar story in U.S. medicine. Drugs that once saved lives become reflexive, prescribed out of habit even as evidence shifts and risks mount. They endure not only because they can help but also because writing a prescription is faster than tackling the harder work of diet, exercise, stress, and sleep.

“The lesson overall is that everybody is an ‘N-of-1,’” Wolfson said. “On paper, a drug can look highly beneficial, but for the individual, it may be detrimental. First, do no harm.”