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Carvedilol and bisoprolol as initial therapy for adult hypertension without compelling indications


Although beta blockers have been used as initial therapy for ischemic heart diseases and heart failure, the beneficial effects of beta blockers are controversial compared with other antihypertensive agents as initial therapy for hypertension without compelling indications. Moreover, atenolol has been most commonly used with beta blockers. The objective of the present systematic review associated with the Japanese Society of Hypertension (JSH) 2019 Hypertension Guideline (Clinical Question 6) was to assess the outcomes (cardiocerebrovascular mortality, total cause mortality, hypotension, bradycardia, other adverse effects, and changes in systolic blood pressure (SBP)) of currently used carvedilol and bisoprolol as initial therapy for adult hypertension without compelling indications. Two independent systematic reviewers searched randomized controlled trials (RCTs) up to October 2017 in the Cochrane Hypertension Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE Ovid, EMBASE Ovid, and Finally, eight RCTs with 2494 participants were identified to meet our inclusion criteria. There were no RCTs in which cardiocerebrovascular mortality, total cause mortality, hypotension, and bradycardia were assessed between carvedilol or bisoprolol and placebo. SBP-lowering effects were significantly increased for bisoprolol compared with placebo. Here, 50 mg carvedilol significantly reduced SBP compared with placebo, whereas 12.5 mg or 25 mg did not. Regarding adverse effects, no differences were noted between carvedilol and placebo (two RCTs, 286 participants, moderate certainly evidence). In conclusion, current evidence does not support carvedilol or bisoprolol as first-line therapy for adult hypertension without compelling indications.

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  1. Wright JM, Musini VM. First-line drugs for hypertension. Cochrane Database Syst Rev. 2009; CD001841.

  2. Wong GWK, Laugerotte A, Wright JM. Blood pressure lowering efficacy of dual alpha and beta blockers for primary hypertension (Review). Cochrane Database Syst Rev. 2015; CD007449.

  3. Wiysonge CS, Bradley HA, Volmink J, Mayosi BM, Opie LH. Beta-blockers for hypertension (Review). Cochrane Database Syst Rev. 2017; CD002003.

  4. Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Pre-ferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;89:873–80.

    Google Scholar 

  5. McPhillips JJ, Schwemer GT, Scott DI, Zinny M, Patterson D. Effects of carvedilol on blood pressure in patients with mild to moderate hypertension. A dose response study. Drugs. 1988;36(supple6):82–91.

    Article  Google Scholar 

  6. Asmar RG, Kerihuel JC, Girerd VJ, Safar ME. Effect of bisoprolol on blood pressure and arterial hemodynamics in systemic hypertension. Am J Cardiol. 1991;68:61–64.

    CAS  Article  Google Scholar 

  7. Broekman CP, Haensel SM, Van de Ven LL, Slob AK. Bisoprolol and hypertension: effects on sexual functioning in men. J Sex Marital Ther. 1992;18:325–31.

    CAS  Article  Google Scholar 

  8. Davidov ME, Singh SP, Vlachakis ND, Blumenthal JB, Simon JS, Bryzinski BS. et al. Bisoprolol, a once-a-day beta-blocking agent for patients with mild to moderate hypertension. Clin Cardiol. 1994;17:263–8.

    CAS  Article  Google Scholar 

  9. Frishman WH, Burris JF, Mroczek WJ, Weir MR, Alemayehu D, Simon JS, et al. First-line therapy option with low-dose bisoprolol fumarate and low-dose hydrochlorothiazide in patients with stage I and stage II systemic hypertension. J Clin Pharmacol. 1995;35:182–8.

    CAS  Article  Google Scholar 

  10. Deary AJ, Schumann AL, Murfet H, Haydock SF, Foo RS, Brown MJDouble-blind. placebo-controlled crossover comparison of five classes of antihypertensive drugs. J Hypertens. 2001;20:771–7.

    Article  Google Scholar 

  11. Deary AJ, Schumann AL, Murfet H, Haydock S, Foo RS, Brown MJ. Influence of drugs and gender on the arterial pulse wave and natriuretic peptide secretion in untreated patients with essential hypertension. Clin Sci. 2002;103:493–9.

    CAS  Article  Google Scholar 

  12. Weber MA, Barkris GL, Tarka EA, Iyengar M, Fleck R, Sica DA. Efficacy of a once-daily formulation of carvedilol for the treatment of hypertension. J Clin Hypertens. 2006;8:840–9.

    CAS  Article  Google Scholar 

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Correspondence to Takuya Kishi.

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Kishi, T., Fujii, E. Carvedilol and bisoprolol as initial therapy for adult hypertension without compelling indications. Hypertens Res 42, 496–503 (2019).

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  • hypertension
  • beta blocker
  • carvedilol
  • bisoprolol

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