Carvedilol and bisoprolol as initial 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. 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.