Propranolol, a nonselective beta blocker, is the first-line drug in the management of essential tremor, portal hypertension, migraine prophylaxis, and thyroid storm. Cardioselective beta blockers have a lower side-effect profile and are preferred in the management of coronary heart disease, compensated heart failure, acute coronary syndrome, and certain types of arrhythmias. Nonselective beta blockers (e.g., pindolol, propranolol) inhibit all β receptors and may cause bronchoconstriction, peripheral vasoconstriction, and metabolic imbalances (e.g., hypoglycemia and hyperglycemia, hypertriglyceridemia) in addition to cardiac effects. Cardioselective blockers (e.g., atenolol, bisoprolol) primarily block β 1 receptors in the heart, causing decreased heart rate, cardiac contractility, cardiac workload, and AVN conduction. Beta blockers are a group of drugs that inhibit the sympathetic activation of β-adrenergic receptors.
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