Bisoprolol in essential hypertension: effects on 24 hour ambulatory blood pressure and metabolic profile in Chinese patients

Abstract

Purpose of the study: Some studies have found beta-blockers (BBs) inferior to other antihypertensive treatments in reducing stroke incidence and overall mortality possibly because of adverse effects on glucose and lipid profiles. The aim of this study was to investigate the genetic and phenotypic factors which influence the metabolic profile and ambulatory blood pressure (BP)-lowering effects of bisoprolol in Chinese patients with essential hypertension. Methods: This was an open-label trial in patients with mild to moderate essential hypertension. Patients received bisoprolol 2.5 mg once daily for 6 weeks after a placebo run-in period. Clinic and 24 hour ambulatory BPs were measured before and after 6-weeks of bisoprolol treatment. Changes in lipids and glucose were evaluated after 6 weeks treatment. Results: 98 patients (54±10 years, 59% male) completed this study. After 6 weeks of treatment, there were significant reductions in clinic systolic BP (SBP), clinic diastolic BP (DBP), and clinic heart rate (HR) of -14.1±10.8 mmHg (p<0.001), -8.2±6.4mmHg (p<0.001) and -6.5±7.6 beats/min (p<0.001), respectively. 24 hour ambulatory SBP, DBP and HR were reduced significantly by -13.5±12.7 mmHg, -8.2±7.4 mmHg, and -9.7±4.9 beats/min (all p <0.001), respectively. Small but significant increases of 0.3±1.0 mmol/L (p=0.002), 1.8±6.2 µmol/L (p=0.005) and 0.01±0.04 mmol/L (p=0.003) were observed in plasma urea, creatinine and urate, respectively. The changes in total cholesterol, HDL-C, triglycerides, LDL-C and non-HDL-C were not significant at -0.05±0.5 mmol/L (p=0.36), -0.03±0.1 mmol/L (p=0.05), -0.01±0.5 mmol/L (p=0.85), -0.03±0.5mmol/L (p=0.56), -0.01±0.5 mmol/L (p=0.79), respectively. There was no significant change in fasting plasma glucose, - 0.02±0.5 mmol/L (p=0.74). Conclusions: The administration of low-dose bisoprolol significantly reduced clinic BP and effectively reduced ambulatory BP over 24 hours. There was no adverse effect on lipids and glucose metabolism in these hypertensive patients. Reduction in heart rate may be an additional benefit in some patients.