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

Takuya Kishi, Eitaro Fujii

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

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 ClinicalTrials.gov. 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.

Original languageEnglish
Pages (from-to)496-503
Number of pages8
JournalHypertension research : official journal of the Japanese Society of Hypertension
Volume42
Issue number4
DOIs
Publication statusPublished - Apr 1 2019

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Bisoprolol
Blood Pressure
Hypertension
Randomized Controlled Trials
Placebos
Mortality
Bradycardia
Hypotension
Therapeutics
Atenolol
MEDLINE
Antihypertensive Agents
Myocardial Ischemia
carvedilol
Heart Failure
Guidelines

All Science Journal Classification (ASJC) codes

  • Internal Medicine
  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Carvedilol and bisoprolol as initial therapy for adult hypertension without compelling indications. / Kishi, Takuya; Fujii, Eitaro.

In: Hypertension research : official journal of the Japanese Society of Hypertension, Vol. 42, No. 4, 01.04.2019, p. 496-503.

Research output: Contribution to journalArticle

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