SBP-lowering effects were significantly increased for bisoprolol compared with placebo .
In conclusion , current evidence does not support carvedilol or bisoprolol as first-line 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 .
Efficacy of a once-daily formulation of carvedilol for the treatment of hypertension.
Beta-blockers with pharmacologic effects that differ from conventional agents might add to antihypertensive treatment options . This study evaluated a new once-daily formulation of the beta-/alpha1-blocker , carvedilol controlled-release ( CR ) , in hypertensive patients off treatment or while still taking up to 2 ( non-beta-blocker ) agents . After a 4-week run-in phase , patients were r and omized either to placebo ( n=76 ) or carvedilol CR 20 mg ( n=82 ) , 40 mg ( n=76 ) , or 80 mg ( n=86 ) once daily . After 6 weeks of treatment , ambulatory blood pressure monitoring was repeated to measure the primary end point of changes in mean 24-hour diastolic blood pressure . During treatment , 24-hour diastolic blood pressure fell in the placebo and carvedilol CR 20-mg , 40-mg , and 80-mg groups by ( mean + /- SE ) 0.4+/-0.9 , 4.4+/-0.9 , 7.9+/-0.9 , and 9.6+/-0.9 mm Hg , respectively ( P < or = .001 , trend test for all carvedilol CR doses with placebo ) . Corresponding 24-hour systolic blood pressure changes were 0.6+/-1.4 , 6.8+/-1.3 , 10.1+/-1.4 , and 12.5+/-1.3 mm Hg , respectively ( P < or = .001 , trend test ) . Diastolic blood pressure trough-to-peak ratios ( placebo-corrected ) based on ambulatory blood pressure monitoring ( trough = mean of 20- to 24-hour post-dose readings ; peak = mean of 3- to 7-hour post-dose readings ) for 20-mg , 40-mg , and 80-mg doses were 0.73 , 0.64 , and 0.65 , respectively . Adverse events , including clinical chemistry values , were similar in the drug-treated and placebo groups . Carvedilol CR has a clinical ly meaningful defined dose-dependent antihypertensive effect that persists throughout a 24-hour period
SBP-lowering effects were significantly increased for bisoprolol compared with placebo .
In conclusion , current evidence does not support carvedilol or bisoprolol as first-line 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 .