Which of the following are contraindications to beta-blocker use?

• A. Breathing problems (asthma, COPD, chronic bronchitis); congestive heart failure; symptomatic bradycardia; symptomatic hypotension; greater than first-degree heart block
• B. Only seasonal allergies
• C. Myopia and hyperopia
• D. Age over age 80

Answer: (B)

Beta-blockers work by dampening sympathetic signals to the heart and airways, so the main safety concern is conditions that would be worsened by slower heart rate, reduced contractility, or bronchoconstriction. The strongest contraindications are breathing problems like asthma or COPD, congestive heart failure, symptomatic bradycardia, symptomatic hypotension, and higher-than-first-degree heart block. These situations mean the body could be unable to tolerate the decreased heart rate or airway effects that beta-blockers can provoke. Seasonal allergies, refractive errors like myopia or hyperopia, and age by itself do not constitute contraindications, so they are not reasons to avoid beta-blocker therapy.