From the Guidelines
Bisoprolol can cause hypotension as a side effect, although the incidence is relatively low, with only 3 patients (0.6%) randomized to bisoprolol reaching this beta-blocker–related safety end point in a study published in the Circulation journal 1.
Mechanism and Side Effects
Bisoprolol is a beta-blocker medication that works by blocking certain receptors in the heart and blood vessels, reducing heart rate and cardiac output, thereby lowering blood pressure. This mechanism of action intentionally reduces blood pressure in hypertensive patients but can sometimes lower blood pressure too much, resulting in hypotension. Symptoms of hypotension may include dizziness, lightheadedness, fatigue, blurred vision, or fainting, especially when standing up quickly.
Patient Monitoring and Risk Factors
Patients taking bisoprolol should monitor their blood pressure regularly and report significant drops to their healthcare provider. The risk of hypotension is higher in elderly patients, those with heart failure, dehydration, or those taking multiple antihypertensive medications.
Dosing and Minimizing Side Effects
Dosing typically starts low (usually 2.5-5 mg once daily) and is gradually increased to minimize this side effect, as seen in a study where the starting dose of bisoprolol was 2.5 mg orally per day if resting heart rate was greater than 50 bpm, and the dose was modified in steps of 1.25 or 2.5 mg per day, up to a maximum dose of 10 mg, aiming for a heart rate of 50 to 70 bpm 1. Some key points to consider when prescribing bisoprolol include:
- Starting with a low dose and gradually increasing as needed
- Monitoring blood pressure and heart rate regularly
- Being cautious in patients with risk factors for hypotension, such as elderly patients or those with heart failure
- Adjusting the dose based on patient response and tolerability, as guided by studies such as the one published in the Circulation journal 1.
From the FDA Drug Label
The most common signs expected with overdosage of a beta-blocker are bradycardia, hypotension, congestive heart failure, bronchospasm, and hypoglycemia. Bradycardia and/or hypotension were noted. IV fluids and vasopressors should be administered. Cardiovascular Bradycardia, palpitations and other rhythm disturbances, cold extremities, claudication, hypotension, orthostatic hypotension, chest pain, congestive heart failure, dyspnea on exertion
Bisoprolol can cause hypotension. This is evident from the overdose symptoms and adverse effects listed in the drug label 2 and 2. Hypotension is a potential adverse effect of bisoprolol, and it may be treated with IV fluids and vasopressors.
- Key points:
- Hypotension is a common sign of beta-blocker overdosage
- Bradycardia and/or hypotension were noted in cases of bisoprolol overdose
- Hypotension is listed as a potential adverse effect of bisoprolol
- Treatment for hypotension includes IV fluids and vasopressors
From the Research
Bisoprolol and Hypotension
- Bisoprolol is a beta-blocker used to treat hypertension, and its effects on blood pressure have been studied in various research papers 3, 4, 5, 6.
- A study published in 2012 found that low-dose bisoprolol significantly decreased home blood pressure and heart rate in patients with essential hypertension 3.
- Another study from 1993 compared the effects of 2.5 and 5 mg of bisoprolol on blood pressure and lipoprotein concentrations in hypertensive patients, and found that both doses reduced blood pressure, with no significant difference in effect 4.
- A 2022 cohort study compared the effectiveness of bisoprolol with other beta-blockers and antihypertensive classes, and found no differences in blood pressure variation and safety outcomes 5.
- A long-term study published in 1986 found that bisoprolol maintained a significant reduction in blood pressure over a period of 10 months, with minimal side effects 6.
- While bisoprolol can lower blood pressure, there is no evidence to suggest that it causes hypotension, which is a condition characterized by abnormally low blood pressure 3, 4, 5, 6.
- In fact, a 2021 study suggested that certain beta-blockers, such as bisoprolol, may be reevaluated in hypertension guidelines for patients with left ventricular hypertrophy to diminish the ventricular arrhythmic risk 7.