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 .
Influence of drugs and gender on the arterial pulse wave and natriuretic peptide secretion in untreated patients with essential hypertension.
Recent studies have suggested a differential influence of mean pressure and pulse pressure on myocardial infa rct ion and stroke , and differences among the major drugs in their efficacy at preventing these individual endpoints . We hypothesized that antihypertensive drugs have differing influences upon the pulse wave even when their effects on blood pressure are the same . We studied 30 untreated hypertensive patients , aged 28 - 55 years , who were rotated through six 6-week periods of daily treatment with amlodipine 5 mg , doxazosin 4 mg , lisinopril 10 mg , bisoprolol 5 mg , bendrofluazide 2.5 mg or placebo . The best drug was repeated at the end of the rotation . Blood pressure readings and radial pulse tonometry ( by Sphygmocor ) were performed at each visit , and blood was taken for measurement of levels of atrial natriuretic peptide and brain natriuretic peptide ( BNP ) . The Sphygmocor derivation of the central aortic pulse wave was used to measure time for transmission of the reflected wave ( T(R ) ) and the augmentation index ( AI ) , which is the proportional increase in systolic pressure due to the reflected wave . There was a dissociation between the effects of the drugs on blood pressure and pulse wave analysis .  Bisoprolol caused the greatest falls in blood pressure and T(R ) , but was the only drug to increase AI . This paradoxical response to bisoprolol was associated with a 3-fold increase in plasma BNP levels . There was a smaller elevation of BNP in women compared with men , as described previously , and this elevation also was associated with significantly higher values of AI . Other drugs reduced AI , and this was associated with a significant decrease in BNP by amlodipine . In conclusion , antihypertensive drugs differ in their short-term effects on augmentation of the systolic pulse wave and secretion of BNP from the heart , regarded as a sensitive measure of strain on cardiomyocytes . These differences may help to explain cause-specific differences in outcome in recent trials
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 .