Multicenter evaluation of the hemodynamic effects of bisoprolol in patients with mild to moderate hypertension

Use of beta-adrenergic receptor blockers in blacks

Beta adrenergic receptor blockers (beta-blockers) are an important class of drugs in the management of patients with cardiovascular diseases. These drugs have been shown to reduce mortality in hypertension and prolong survival in patients with coronary heart disease. Although hypertension and coronary heart disease account for the majority of excess cardiovascular morbidity and mortality in blocks, beta-blockers continue to be underprescribed in this ethnic group. The magnitude of blood pressure reduction in black patients with hypertension has been consistently less during monotherapy with nonselective beta-blockers than with diuretics. However, the highly selective beta-blocker bisoprolol has been shown to be as effective as diuretics and is equally effective in black and nonblack patients with hypertension. In general, no racial differences in efficacy are noted when beta-blockers are used with diuretics as combination therapy for hypertension. Black patients should not be denied beta-blocker therapy because of an anticipated suboptimal response, especially when there are clear indications for treatment (e.g., for migraine, hyperthyroidism, arrhythmia control, and after myocardial infarction).

Low-dose drug combination therapy: an alternative first-line approach to hypertension treatment

To investigate the concept that the initial treatment of hypertension with low doses of two antihypertensives that have different modes of action and additive effects may achieve control of blood pressure and minimize the dose-dependent adverse effects seen with conventional monotherapy, a randomized, double-blind parallel group dose-escalation study was conducted. After a 4 to 5 week placebo washout period, 218 men and women with diastolic blood pressure between 95 and 114 mm Hg were randomly allocated to take: amlodipine (2.5 to 10 mg), enalapril (5 to 20 mg), and the low-dose combination of bisoprolol (2.5 to 10 mg) with 6.25 mg of hydrochlorothiazide (HCTZ). All drugs were administered once daily, titrated to optimal response, and taken for a total of 12 weeks. Blood pressure was measured 24 hours after dose. The response rates (either a diastolic blood pressure < or = 90 mm Hg or a decrease of diastolic pressure > or = 10 mm Hg) were 71% for bisoprolol-6.25 mg HCTZ, 69% for amlodipine, and 45% for enalapril. The mean decreases in systolic/diastolic blood pressure from baseline were 13.4/10.7, 12.8/10.2, and 7.3/6.6 mm Hg for bisoprolol-6.25 mg HCTZ, amlodipine, and enalapril, respectively. The mean change with enalapril was less than the other drugs (p < 0.01), although the once-daily dosing of enalapril and the maximum dose of 20 mg might not have been optimal for this agent.(ABSTRACT TRUNCATED AT 250 WORDS)

Bisoprolol: is this just another beta-blocker for hypertension or angina?

OBJECTIVE

To review the pharmacology, pharmacokinetics, and clinical experience with bisoprolol and make recommendations regarding its potential clinical usefulness, as well as considerations for formulary inclusion.

DATA SOURCES

Reference citations were sought from Index Medicus and Science Citation Index. Data were collected from abstracts and articles describing experimental studies or blind clinical trials.

STUDY SELECTION

Studies designed in a randomized, blind, and placebo-controlled manner were emphasized. Studies also were included if bisoprolol was evaluated comparatively with other agents in a randomized, blind fashion.

DATA EXTRACTION

Data from human studies published in English were evaluated. Studies were assessed by sample size and the clarity of descriptions of methods and results.

DATA SYNTHESIS

Bisoprolol reduces systolic and diastolic blood pressures in patients with hypertension for a 24-hour dosing interval and is associated with beneficial hemodynamic effects in patients with myocardial ischemia. It is devoid of intrinsic sympathomimetic activity and membrane-stabilizing effects at therapeutic dosages. In patients with hypertension, bisoprolol diminishes plasma renin activity, platelet aggregation, effective renal plasma flow, and creatinine clearance. Bisoprolol has minimal effects on glucose tolerance and plasma lipid profiles. Monotherapy with bisoprolol is as effective as with atenolol, nitrendipine, or nifedipine. Low-dose combination therapy with hydrochlorothiazide is at least as effective as either bisoprolol or hydrochlorothiazide alone. Preliminary experience in the management of angina pectoris suggests that bisoprolol is at least as efficacious as atenolol or verapamil. Thus far, reported adverse effects are similar to those of other beta-blockers. No clinically important drug interactions have been reported at this time.