In contrast to the initial drug treatment of hypertension, ‘second line’ therapy has not been extensively studied. As a prelude to a more definitive controlled trial, a multicentre randomised open study was conducted with bisoprolol, a new β-blocker with high β1-selectivity and once-daily dosage. 558 patients with uncomplicated mild to moderate essential hypertension were initially treated with bisoprolol 10mg once daily for 4 weeks. A target diastolic blood pressure of below 95mm Hg was reached in 74.9% of the population. The ‘nonresponders’ (135 patients) were randomised into 4 different groups: I, bisoprolol 20mg; II, bisoprolol 10mg + hydrochlorothiazide 25mg + amiloride 2.5mg; III, bisoprolol 10mg + enalapril 10mg; IV, bisoprolol 10mg + nifedipine 20mg twice daily. Target blood pressure was achieved in Group I: 91% (21/23); Group II: 83% (34/41); Group III: 88% (35/40); Group IV: 94% (29/31) [differences statistically nonsignificant]. Mild clinical adverse drug reactions were recorded in 4 patients in Group I, 3 in Group II, 1 in Group III, and 3 in Group IV.
Thus, in those who failed to reach target blood pressure with bisoprolol 10mg for 4 weeks, bisoprolol 20mg appears to have a similar efficacy rate to a treatment combining bisoprolol with another antihypertensive agent. Combinations of bisoprolol 10mg with enalapril or nifedipine seem as efficacious as the more traditional combination with a diuretic.
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