CARVEDILOL IN PATIENTS WITH UNCONTROLLED AND RESISTANT ARTERIAL HYPERTENSION

The use of beta-blockers in treating resistant hypertension remains poorly understood. While PATHWAY-2 showed a systolic blood pressure benefit with bisoprolol, further research is needed to evaluate other beta-blockers in terms of the effect of systolic blood pressure, assess diastolic blood pressure effects, and guide management in patients intolerant to CCBs as well.

Our study aimed to evaluate the efficacy of Carvedilol (non-selective beta-blocker with alpha-1 blocking function) in the management of resistant hypertension, including in patients intolerant to calcium channel blockers. The study compared the efficacy of carvedilol in two groups: patients newly initiated on carvedilol and patients switched from another beta-blocker to carvedilol.

We create two groups: 1. Add Carvedilol group (when add Carvedilol in beta blocker naïve patients with resistant hypertension, PATHWAY 2 like patients with triple therapy of CCB, RAAS inhibitor and diuretic) and 2. Switch to Carvedilol group (CCB intolerant patients with RAAS inhibitor, diuretic and beta blocker, when beta blocker bisoprolol is replaced with carvedilol). The primary endpoint was the change in systolic (SBP) and diastolic (DBP) blood pressure from baseline to the end of the study. Secondary endpoints included the correlation between blood pressure reduction and gender, BMI, and age, also safety parameters (hypotension, bradycardia, new onset type 2 diabetes mellitus) Results: The study results demonstrated significant reductions in both SBP and DBP in both treatment groups, including those with group 1 - Add Carvedilol (on RAAS inhibitors, CCBs, and diuretics) and those with group 2 - Switch to Carvedilol (those with CCB intolerance, on RAAS inhibitor, diuretic, and beta blocker-Bisolrolol). Carvedilol was well-tolerated, with no significant adverse events reported.

This study provides evidence supporting the use of carvedilol in patients with resistant hypertension, including those intolerant to CCBs.