Does Mirabegron Cause Hypotension?
No, mirabegron does not cause hypotension—it causes hypertension as its primary cardiovascular adverse effect. 1, 2, 3
Cardiovascular Effects: Hypertension, Not Hypotension
Mirabegron is a β3-adrenoreceptor agonist that increases blood pressure rather than decreasing it:
Hypertension occurs in 7.5-11.3% of patients taking mirabegron compared to 7.6% on placebo, making it one of the most frequent adverse events. 3
The drug is contraindicated in patients with severe uncontrolled hypertension precisely because it can worsen blood pressure control. 1, 2, 4
Dose-dependent blood pressure increases occur, with systolic blood pressure rising by 7.1 mm Hg at 150 mg doses and 9.3 mm Hg at 200 mg doses (compared to 2.2 mm Hg at the standard 50 mg dose). 5
Required Blood Pressure Monitoring
Regular blood pressure monitoring is essential, especially during initial treatment:
Monitor blood pressure periodically throughout treatment, with particular attention during the first weeks of therapy. 2, 4
In patients with well-controlled hypertension, approximately 6.5% experienced blood pressure increases requiring discontinuation of mirabegron. 6
Home blood pressure monitoring can aid in earlier detection of worsening control in susceptible patients. 6
Other Cardiovascular Effects
Beyond hypertension, mirabegron causes:
Modest heart rate increases: +1.2 bpm on average, with a 9.0 bpm increase at supratherapeutic 200 mg doses. 5, 7
No increased risk of major cardiovascular adverse events (arrhythmia, coronary artery disease, stroke) compared to placebo when baseline cardiovascular risk factors are controlled. 8
Cardiovascular-related adverse events remain uncommon (0.4-1.5%) and comparable to placebo (0.9%). 8
Clinical Implications
Mirabegron does not affect voiding urodynamic parameters and causes only small changes in post-void residual volume, distinguishing it from antimuscarinics. 1
Discontinue mirabegron if:
- Blood pressure becomes uncontrolled or significantly elevated 2, 6
- Worsening voiding symptoms or urinary stream develops 1, 4
The drug remains well-tolerated in elderly patients with multiple comorbidities, provided hypertension is monitored appropriately. 1, 2, 9