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Clinical outcome in hypertensive patients treated with amlodipine plus bisoprolol or plus valsartan

Yi-Heng Li1, Hui-Wen Lin1, Ulrike Gottwald-Hostalek2

  • 1Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.

Current Medical Research and Opinion
|June 28, 2024
PubMed

Insights

Amlodipine plus bisoprolol (A+B) and amlodipine plus valsartan (A+V) showed similar outcomes for death, atherosclerotic cardiovascular disease events, and heart failure. However, the A+B combination demonstrated a reduced risk of hemorrhagic stroke compared to A+V.

Area of Science:

  • Cardiology
  • Pharmacology
  • Public Health

Background:

  • Beta-blockers are not recommended as first-line hypertension treatment due to lower efficacy in stroke prevention.
  • Combination therapy is common for blood pressure control.
  • Comparing amlodipine plus bisoprolol (A+B) with amlodipine plus valsartan (A+V) provides insights into treatment efficacy.

Purpose of the Study:

  • To compare clinical outcomes between amlodipine plus bisoprolol (A+B) and amlodipine plus valsartan (A+V) in hypertensive patients.
  • To evaluate the efficacy of A+B versus A+V in preventing all-cause death, atherosclerotic cardiovascular disease (ASCVD) events, hemorrhagic stroke, and heart failure.

Main Methods:

  • A population-based cohort study utilized data from the Taiwan National Health Insurance Research Database (2012-2019).
  • Adult hypertensive patients initially on amlodipine monotherapy, then switched to A+V or A+B, were included.
  • Multivariable Cox proportional hazards models assessed treatment outcomes.

Main Results:

  • The study included 4311 patients in the A+B group and 10980 in the A+V group.
  • After a mean follow-up of 4.34 years, no significant differences were observed in all-cause death, ASCVD events, or heart failure between the groups.
  • The A+B group showed a significantly lower risk of hemorrhagic stroke (aHR 0.70, 95% CI 0.52-0.94).

Conclusions:

  • Amlodipine plus bisoprolol (A+B) and amlodipine plus valsartan (A+V) combinations exhibit comparable efficacy regarding mortality, ASCVD events, and heart failure.
  • The A+B combination therapy is associated with a reduced risk of hemorrhagic stroke.
  • Safety outcomes were similar between the two treatment groups.
Abstract

Keywords:
Beta-blockerblood pressure controlstroke

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