To Evaluate the Clinical Efficacy of Combination of Low Dose Bisoprolol Fumarate and Low Dose Hydrochlorothiazide with Bisoprolol Alone in Stage I and II Hypertension

OBJECTIVE: Control of hypertension by the use of low dose combination therapy is associated with greater efficacy, less side effects and higher response rates as the result of complementary mechanisms of antihypertensive effect. Present study is an effort to evaluate the efficacy and safety of combined low dose of bisoprolol fumarate and hydrochlorothiazide therapy as compared to bisoprolol alone in stage I and II hypertension. METHODS: 120 hypertensive patients were taken from the outpatient department of medicine, in tertiary care medical hospital in Northern India. Diagnosis of hypertension was according to Joint National Committee (JNC) VII guidelines. Study was conducted as randomised, controlled open label study over a period of six weeks. Patients were randomly allocated into two groups. Group I patients were started with low dose combination of bisoprolol 2.5 mg and hydrochlorothiazide 6.25mg once daily. Subsequent titration was carried out with bisoprolol up to maximum dose of 10mg with 12.5mg hydrochlorothiazide. Group II was started on bisoprolol alone 5mg and increased up to 20mg according to response. The study parameters were recorded weekly. RESULTS: At the end of study the mean fall of supine blood pressure for combination was 16.4±4.21/12.73±4.59mmHg and for bisoprolol it was 12.53±3.89/10.13±3.36 mmHg. The difference was statistically significant showing that the combination achieved early and greater reduction in both systolic and diastolic blood pressure with comparatively fewer side effects. CONCLUSION: The combination of low doses of bisoprolol and hydrochlorothiazide is both safe and effective as compared to bisoprolol monotherapy in the management of Stage I and II hypertension.   KEYWORDS: Bisoprolol, Hydrochlorothiazide, Hypertension, Low-dose combination, Diuretic.