Bisoprolol Dosing for Hypertension
The recommended initial dose of bisoprolol for hypertension is 5 mg once daily, which can be titrated up to a maximum of 20 mg once daily if needed for blood pressure control. 1
Dosing Algorithm
Initial Dosing
- Standard initial dose: 5 mg once daily 1
- Special populations requiring lower initial dose (2.5 mg once daily):
- Patients with hepatic impairment
- Patients with renal dysfunction (creatinine clearance <40 mL/min)
- Elderly patients with significant renal or hepatic dysfunction 1
Dose Titration
- Evaluate blood pressure response after 1-2 weeks
- If blood pressure remains inadequate on 5 mg:
Effectiveness by Dose
- 5 mg daily: Produces mean diastolic BP reduction of 6.3 mmHg 2
- 10 mg daily: Produces mean diastolic BP reduction of 8.8 mmHg 2
- 20 mg daily: Produces mean diastolic BP reduction of 10.1 mmHg 2
Clinical Considerations
Advantages of Bisoprolol
- Once-daily dosing provides 24-hour blood pressure control 2
- Beta-1 selective, minimizing non-cardiac side effects 3
- Near maximal antihypertensive effects achieved within 1 week of therapy 2
- Well-tolerated in patients with mild to moderate hypertension 4
Special Populations
- Renal impairment: Start with 2.5 mg daily when creatinine clearance <40 mL/min 1
- Hepatic impairment: Start with 2.5 mg daily 1
- Elderly patients: No dose adjustment needed unless significant renal or hepatic dysfunction is present 1
Monitoring
- Assess blood pressure response at trough effect (24 hours post-dose)
- Monitor heart rate (bisoprolol typically reduces heart rate by 5-10 beats/min depending on dose) 2
- Evaluate for common beta-blocker side effects (fatigue, dizziness, bradycardia)
Important Considerations
- Bisoprolol is preferred in patients with heart failure with reduced ejection fraction (HFrEF) among beta-blockers 3
- Avoid abrupt cessation as this may lead to rebound hypertension 3
- Beta-blockers are not recommended as first-line agents for hypertension unless the patient has ischemic heart disease or heart failure 3
When treating hypertension with bisoprolol, starting with 5 mg once daily and titrating based on blood pressure response provides an effective approach with minimal side effects for most patients.