Bisoprolol in the Treatment of Hypertension in the Elderly

Home , Bisoprolol

Journal of Human Hypertension (1998) 12, 643–644  1998 Stockton Press. All rights reserved 0950-9240/98 $12.00 http://www.stockton-press.co.uk/jhh Bisoprolol in the treatment of hypertension in the elderly

M Broncel, J Chojnowska-Jezierska and H Adamska-Dyniewska Department of Clinical Pharmacology MAM, Lodz, Poland

The aim of the study was to examine the hypotensive after bisoprolol (5 mg) administration. The hypotensive efficacy and tolerance of bisoprolol in elderly patients. efficacy of bisoprolol in the elderly and younger patients Sixty patients (40 Ͻ65 years and 20 Ͼ65 years) with was similar. Before and after treatment the mean differ- mild-to-moderate essential hypertension (diastolic ence of systolic BP (SBP) was 19.6 ± 12.5 mm Hg and blood pressure (DBP) between 95 and 109 mm Hg) were DBP 9.6 ± 6.2 mm Hg in the younger patients and included in the study. After a 2-week run-in period on 16.1 ± 13.6 mm Hg and 9.5 ± 6.0 mm Hg in the elderly placebo, patients began bisoprolol therapy (5 mg/d) for patients. Bisoprolol produced a similar reduction in 12 weeks. After 4 weeks the dose was increased to heart rate (23.1% vs 17.1%) in the estimated groups. The 10 mg/d in those with a DBP у95 mm Hg. Additionally, tolerance of bisoprolol was good in both groups. There in 10 patients over 65 years old, 24-h ambulatory BP were no significant differences in adverse drug reac- monitoring (ABPM) was performed, after placebo and tions between the groups.

Keywords: bisoprolol; hypertension; elderly

Introduction ometer in the sitting position, after a 10-min rest, three times. BP was measured on the first day of the For several years it has been thought that beta-adre- placebo phase and three times during the active nergic blockers are less effective in elderly patients. treatment. Additionally at each visit the heart rate However, studies on the effectiveness of beta-block- and side effects were assessed. Furthermore in 10 ers in the elderly have yielded conflicting results. At patients over 65 years, 24-h ambulatory BP monitor- present it is postulated that new beta adrenoceptor ing (ABPM by Oxford Medilog system) was perfor- ␤ antagonists with high 1 selectivity are an alterna- med, after placebo and after bisoprolol (5 mg) tive to other drugs in elderly patients with mild-to- administration. moderate essential hypertension. Owing to the advantageous properties these drugs are well tolerated in the elderly. In the present study we com- Results pared the anti-hypertensive effect and tolerance of Ͻ Bisoprolol produced a similar reduction in BP in bisoprolol in two population groups (young 65 both the elderly and younger patients. After the years, and elderly Ͼ65 years). Bisoprolol is a new ␤ treatment the mean difference of SBP and DBP was high 1-selective adrenoceptor antagonist without 19.6/9.6 mm Hg in patients Ͻ65 and 16.1/9.5 intrinsic sympathomimetic activity (ISA), and with in patients Ͼ65 years. We observed a similar a plasma elimination half-life of 10–12 h permitting reduction in heart rate in both groups (23.1% vs treatment with once daily dose. 17.1%, Table 1). The reduction in SBP and DBP in the elderly patients treated with bisoprolol (5 mg) Materials and methods was maintained throughout the 24-h dosing interval (Figure 1). There was no significant difference in The study was performed in 60 patients with mild- adverse drug reactions and quality of life. Only two to-moderate hypertension (diastolic blood pressure patients after 1 month of active treatment were with- (DBP) 95–109 mm Hg; systolic BP (SBP) 160–180 drawn from the study because of bradycardia. Fur- mm Hg). The patients were divided into two groups: thermore the deterioration of heart failure and of group 1 included 40 patients Ͻ65 years (mean age ± peripheral circulation in the elderly was not 49 5.4; 19 men, 21 women; and group 2 was com- observed. posed of 20 patients Ͼ65 years (mean age 67.6 ± 3.8; 9 men, 11 women). All patients received bisoprolol (5 mg/d) and after 4 weeks, if DBP was у95 mm Hg, Discussion the dosage was doubled. The total active treatment phase lasted 12 weeks. BP was measured in all The use of drugs of all types in the elderly is more patients with a standard mercury sphygmoman- difficult than in younger patients, for the aging pro- cess is associated with altered pharmacokinetics and drug responses.1 The use of beta-blockers in the Correspondence: Marlena Broncel,Department of Clinical Phar- treatment of hypertension in elderly patients is not macology, MMA, Bieganski Hospital, 1/5 Kniaziewicza Street, 91- clear. It has been claimed that beta-blockers are less 347 Lodz, Poland effective than diuretics.2 However, Neutel et al3 Bisoprolol in the elderly M Broncel et al 644 Table 1 Blood pressure and heart rate during the treatment (×¯±s.d.)

Group 1 Group 2 Statistical comparison After placebo After active P After placebo After active P between treatment treatment group 1 and 2

Mean SBP (mm Hg) 166.8 ± 10.3 147.2 ± 14.5 Ͻ0.001 165.6 ± 11.2 149.5 ± 17.4 Ͻ0.001 Mean difference (mm Hg) 19.6 ± 12.5 16.1 ± 13.6 NS Mean DBP (mm Hg) 98.2 ± 8.6 88.6 ± 8.5 Ͻ0.001 98.9 ± 5.6 89.4 ± 2.9 Ͻ0.001 Mean difference (mm Hg) 9.6 ± 6.2 9.5 ± 6.0 NS Heart rate Mean values 89.4 ± 13.8 68.75 ± 8.5 Ͻ0.001 83.0 ± 11.6 68.8 ± 8.8 Ͻ0.001 Mean changes −23.1% −17.1% NS

␤ terised by a blunted baroreflex and 1-adrenoceptor- mediated reponses, decreased vascular compliance and increased peripheral vascular resistance.1 One possible explanation for the enhanced efficacy of bisoprolol in the elderly may be that it is more lipid soluble than atenolol.4 Sympathetic nervous system activity may be critical in patients over 65 years in whom reduced arterial compliance may contribute to hypertension and central drug effects may be important in regulating BP.4 Owing to the advantageous pharmacodynamic and pharmacokinetic properties bisoprolol is better tolerated than other beta-blocking agents in the elderly.5 The implication of our study is that bisoprolol is very efficient and safe in the treatment of hypertension in patients over 65 years of age.

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