You can get suppressors with muzzle brake end caps. A-Tec do them. As does Maniatis. Sounds counter productive but they do still take a lot of the bark out because it's still much lower pressure gas going through the brake vs unsuppressed. Personally, I'm still not entirely convinced because they are radial rather than directional - so I'd have thought the outward forces would end up cancelling out, letting the muzzle jump in whatever direction it was going to anyway. Happy to be proved wrong on that one though - the guys that use them certainly swear by them.
Muzzle brakes on their own are can be pretty unpleasant for those nearby. And they suck inside of the concrete booths at the NZHA range. Not a problem on the hillside when it's just you looking to bowl over one or two animals - but definitely pack ear plugs.
Mechanically they don't impede accuracy. They do affect my own ability to shoot a rifle accurately though as the cartridge gets bigger and the blast becomes more concussive and flinch inducing. ymmv.
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