Comparison of a Low Dose Bisoprolol/Hydrochlorothiazide Combination with Valsartan in the Treatment of Hypertension

Abstract

Background: Beta-blocker thiazide combinations have been criticized because they may have adverse metabolic effects. We compared a low dose bisoprolol (B) hydrochlorothiazide (HCTZ) combination (Lodoz) with valsartan on clinic blood pressure (BP), ambulatory BP (ABP), heart rate (HR) and metabolic parameters in Chinese patients with mild-moderate hypertension. Methods: Patients on no therapy were randomized to open-label B/HCTZ 2.5/6.25 mg or valsartan 80 mg daily following a placebo run-in. Doses were increased to 5/6.25 mg B/HCTZ or 160 mg valsartan after 4 weeks if target BP was not achieved and treatment continued for 16 weeks. BP, HR and metabolic parameters were evaluated 4 weekly. Results and discussion: After 16 weeks, reductions in clinic BP were similar in 23 patients on B/HCTZ (-22.0±11.3/-11.3±7.1 mmHg) and 21 patients on valsartan (-19.5±13.9/-10.3±9.6 mmHg). All ABP reductions were also similar with the 2 treatments. All HRs were reduced significantly more with B/HCTZ (clinic -8.4±7.8, p<0.001) than valsartan (+2.6±8.3, p=0.29). There were small but significant increases in plasma urea (0.7±1.1 mmol/L) and urate (0.04±0.04 mmol/L) and decrease in HDL cholesterol (0.1±0.2 mmol/L) with B/HCTZ but no significant changes in other lipids, glucose, insulin or HbA1c and none of the metabolic changes with B/HCTZ were significantly different from those with valsartan, which had no significant effects. Both treatments were well tolerated without any drug related adverse events. Conclusions: Low-dose B/HCTZ was as effective in lowering BP as valsartan with minimal metabolic effects. Reduction in resting HR with B/HCTZ may be an advantage in some patients.