What dose of Coreg (carvedilol) is needed to improve blood pressure control in a patient with impaired blood pressure control who is currently on bisoprolol 5mg?

Switching from Bisoprolol to Carvedilol for Blood Pressure Control

Do not switch from bisoprolol to carvedilol solely for blood pressure control—instead, add a calcium channel blocker or thiazide diuretic to the existing bisoprolol regimen, as beta-blockers are not first-line agents for hypertension and switching between them offers no advantage for BP management. 1

Why Not Switch Beta-Blockers?

• Beta-blockers are not recommended as first-line antihypertensive agents unless the patient has ischemic heart disease or heart failure 1
• Bisoprolol 5 mg daily is already providing beta-blockade; switching to carvedilol does not address the fundamental issue of inadequate BP control 1
• Both bisoprolol and carvedilol lower BP through similar mechanisms (beta-blockade), though carvedilol adds alpha-blockade 1

Recommended Approach for BP Control

Add Appropriate Antihypertensive Agents

First, add a calcium channel blocker (amlodipine 5-10 mg daily) or thiazide diuretic to bisoprolol rather than switching beta-blockers 1

• The combination of beta-blocker plus CCB or diuretic provides additive BP reduction through complementary mechanisms 1
• Target BP is <130/80 mmHg 1

If Switching is Absolutely Necessary

If there is a compelling reason to switch (e.g., heart failure with reduced ejection fraction where carvedilol is preferred), use the following conversion: 1

• Stop bisoprolol 5 mg once daily
• Start carvedilol 6.25 mg twice daily (12.5 mg total daily dose) 2
• Titrate carvedilol up to 12.5 mg twice daily after 7-14 days if tolerated and BP remains elevated 2
• Maximum dose for hypertension: 25 mg twice daily (50 mg total daily) 2

Carvedilol Dosing Specifics for Hypertension

• Starting dose: 6.25 mg twice daily with food 2
• Maintain for 7-14 days, then increase to 12.5 mg twice daily if needed 2
• Can further increase to 25 mg twice daily after another 7-14 days if tolerated 2
• Full antihypertensive effect seen within 7-14 days at each dose level 2
• Take with food to reduce orthostatic effects 2

Critical Caveats

Avoid Common Pitfalls

• Do not abruptly discontinue bisoprolol—taper over 1-2 weeks while initiating carvedilol to avoid rebound hypertension 1
• Monitor for orthostatic hypotension when starting carvedilol, especially if patient is on other antihypertensives 2
• Carvedilol causes more orthostatic effects than bisoprolol due to alpha-blockade 2

When Beta-Blocker Monotherapy Fails

• Adding a diuretic produces additive effects and exaggerates orthostatic hypotension with carvedilol 2
• Consider CCB as preferred add-on agent to minimize orthostatic risk 1
• If patient is African American, prioritize CCB or thiazide diuretic over increasing beta-blocker dose 3

Monitoring After Any Change

• Assess BP within 1 week of dose changes, using standing systolic pressure 1 hour after dosing as guide for tolerance 2
• Recheck at 7-14 days to evaluate full effect at each dose level 2
• Monitor heart rate (avoid <50 bpm) and signs of fluid retention 1