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 .
Bisoprolol, a once‐a‐day beta‐blocking agent for patients with mild to moderate hypertension
The 24‐h blood pressure control of bisoprolol , a new beta1‐selective , beta‐blocking agent , was studied in 240 mild to moderate hypertensive patients in this 4‐week , r and omized , double‐blind , placebo‐controlled trial . A once‐daily dosing schedule was evaluated by comparing bisoprolol 's antihypertensive effectiveness and safety at 24 h postdose and 3 h postdose , the latter time intended to correspond to peak effectiveness . Results from this trial demonstrated the antihypertensive effectiveness of once‐daily bisoprolol at doses ranging from 5‐20 mg . Mean reductions from baseline diastolic blood pressure , measured 24 h postdose , were 6.3,8.8 , and 10.1 mmHg for patients receiving bisoprolol 5 , 10 , and 20 mg , respectively , compared with 1.6 mmHg for placebo‐treated patients ( p < 0.01 ) ; mean reductions from baseline systolic blood pressure for the bisoprolol groups were 8.6 , 8.6 , and 10.9 mmHg , respectively , versus 3.3 mmHg for placebo ( p≤0.01 ) ; and mean reductions from baseline heart rate for the bisoprolol groups were 5.1,7.1 , and 10.2 beats/min , respectively , compared with a 0.9 beats/min increase in heart rate for the placebo group ( p < 0.01 ) . The response rates  for bisoprolol‐treated patients ranged from 47 to 70 % compared with 18 % for patients on placebo ( p < 0.01 ) . Antihypertensive effects were dose‐related and sustained over the 24‐h dosing interval . Near maximal antihypertensive effects were achieved within 1 week of initiation of therapy with bisoprolol and were sustained over the course of the trial
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 .