Blood Pressure Medications: Bisoprolol vs. Propranolol

Q: Blood Pressure Medications: Bisoprolol vs. Propranolol

Hello GRACE： <br>Bisoprolol hemifumarate： Indications 1. <br>As a beta-blocker, it reduces heart rate and inhibits plasma renin activity. <br>2. <br>For patients with angina, it decreases cardiac workload by blocking β-1 receptors in the myocardium, thereby reducing myocardial ox

Medication consultation

Hello, Pharmacist:
I was diagnosed with hypertension over a year ago and have been taking Bisoprolol hemifumarate 2.5mg (half of a 5mg tablet) daily.
I have been on this medication for more than a year (sometimes half a tablet or even less).
Recently, my morning blood pressure readings have often been low, such as 86/60 or 98/70.
My doctor felt that my blood pressure was too low and switched me to Propranolol Hydrochloride 10mg, taking half a tablet in the morning and as needed in the evening.
The doctor mentioned that Bisoprolol is a long-acting medication, while Propranolol is short-acting.
However, after just one day on the new medication, my blood pressure seemed to rise to 150/90.

I have a couple of questions:
1.
Are these two medications the same? I recall a doctor mentioning that they are both β-Blockers, but that Bisoprolol has a better antihypertensive effect, while Propranolol is better for heart rate control?
2.
I feel that since I started taking Coenzyme Q10 daily, my blood pressure has decreased.
Does Coenzyme Q10 actually have antihypertensive effects?
P.S.
I am unsure if the increase in blood pressure is due to psychological factors or the change in medication, so I thought I would consult the pharmacist first and observe for a few days before returning for a follow-up.
Thank you very much for your response!

GRACE, 50~59 year old female. Ask Date: 2018/10/03

Dr. Hou Fangmin reply Pharmacology

Hello GRACE:
Bisoprolol hemifumarate: Indications 1.
As a beta-blocker, it reduces heart rate and inhibits plasma renin activity.
2.
For patients with angina, it decreases cardiac workload by blocking β-1 receptors in the myocardium, thereby reducing myocardial oxygen demand and alleviating or relieving angina symptoms.

Precautions: 1.
Bisoprolol may enhance the effects of other antihypertensive medications when used concurrently.
It may cause excessive bradycardia when combined with other drugs.
2.
Caution is advised when using Bisoprolol with myocardial depressants.
3.
The use of Bisoprolol may increase the efficacy of insulin or oral hypoglycemic agents, so diabetic patients should use it cautiously, as it may mask symptoms of hypoglycemia (especially tachycardia).
Propranolol: Indications 1.
It reduces heart rate and myocardial contractility, inhibits renin release, and suppresses sympathetic nervous impulses that cause vasoconstriction and increased heart rate from the brainstem.

Precautions: Propranolol may promote bronchospasm in diabetic patients and can mask the tachycardia associated with hypoglycemia.
Caution is advised when diabetic patients use this medication alongside hypoglycemic treatments.
Both are beta-blockers that affect the heart, thereby lowering blood pressure.
The physician will monitor heart sounds and blood pressure to adjust treatment accordingly.
Q10: Does it help with hypertension? It is available as both a dietary supplement and a medication.
However, Q10 may interact with the oral anticoagulant Warfarin, potentially reducing its anticoagulant effect.
Therefore, caution is advised when taking this medication.
If you do not have hypertension and wish to use Q10 for maintenance, you may experience discomfort.
It is important to inform your doctor that you are taking Q10.
Wishing you peace and joy.

Reply Date: 2018/10/03

More Info

When it comes to managing high blood pressure (hypertension), understanding the differences between medications like Bisoprolol and Propranolol is crucial. Both of these medications belong to a class of drugs known as beta-blockers, which work by blocking the effects of adrenaline on the heart and blood vessels, ultimately leading to a decrease in heart rate and blood pressure. However, they have different properties and indications that can affect their use in clinical practice.

1. Differences Between Bisoprolol and Propranolol
Bisoprolol is a selective beta-1 blocker, which means it primarily affects the heart. It is often prescribed for hypertension and heart failure due to its ability to lower heart rate and reduce myocardial oxygen demand. Bisoprolol is considered a long-acting medication, which means it can provide stable blood pressure control over a 24-hour period with once-daily dosing. This characteristic makes it a preferred choice for many patients with chronic hypertension.

Propranolol, on the other hand, is a non-selective beta-blocker, affecting both beta-1 and beta-2 receptors. This means it can lower heart rate and blood pressure but also has effects on other systems, such as the lungs (where it can cause bronchoconstriction) and peripheral blood vessels. Propranolol is often used for conditions such as anxiety, migraine prophylaxis, and certain types of arrhythmias. It is classified as a short-acting medication, which may require multiple doses throughout the day to maintain its effects.

Your observation that Bisoprolol may have a better antihypertensive effect compared to Propranolol is consistent with clinical experiences. Bisoprolol's selectivity for beta-1 receptors allows for more targeted action on the heart, leading to effective blood pressure management with potentially fewer side effects related to bronchial constriction, which can be a concern with non-selective beta-blockers like Propranolol.

2. Effects of Coenzyme Q10 on Blood Pressure
Regarding your question about Coenzyme Q10 (CoQ10), there is some evidence suggesting that it may have a modest effect on lowering blood pressure. CoQ10 is an antioxidant that plays a crucial role in energy production within cells, particularly in the heart. Some studies have indicated that supplementation with CoQ10 can lead to a reduction in systolic and diastolic blood pressure, particularly in individuals with hypertension. However, the effects can vary from person to person, and it is not a substitute for prescribed antihypertensive medications.

3. Blood Pressure Fluctuations and Psychological Factors
The fluctuations in your blood pressure readings, particularly the increase to 150/90 after switching to Propranolol, could be influenced by several factors. It’s essential to consider both physiological and psychological aspects. Stress and anxiety can significantly impact blood pressure, potentially leading to temporary spikes. Additionally, the adjustment period when switching medications can also lead to variations in blood pressure as your body adapts to the new medication.

Conclusion
In summary, while both Bisoprolol and Propranolol are beta-blockers, they have different mechanisms of action and clinical uses. Bisoprolol is generally preferred for hypertension due to its selective action and longer duration of effect. Propranolol, while effective, may not provide the same level of blood pressure control and can have additional side effects due to its non-selective nature.

If you are experiencing significant fluctuations in blood pressure, it is crucial to monitor your readings and discuss them with your healthcare provider. They may need to adjust your medication regimen or explore other underlying factors contributing to these changes. Additionally, if you are taking CoQ10, inform your doctor, as they can provide guidance on its use alongside your prescribed medications. Always consult your healthcare provider before making any changes to your medication or supplement regimen.

Similar Q&A

Choosing the Right Beta-Blocker for Hypertension: Tenormin Alternatives Explained

I am using Tenormin (Atenolol), but I am experiencing diarrhea and bradycardia. I read in the media that in 2006, the UK classified Atenolol as a fourth-line medication rather than a first-line treatment. If I still want to use a beta-blocker, which is better among Concor (Bisopr...

Dr. He Dongjin reply Cardiology
Hello, Concor and Dilatrend may have a weaker and shorter effect compared to Inderal, which might not be suitable. Changhua Hospital is concerned about you.

Understanding the Differences Between Propranolol and Carvedilol for Heart Health

Dear Ms. Lai, I would like to inquire about the differences between Propranolol and Carvedilol (Dilatrend). Previously, I was taking Propranolol twice a day, but during my follow-up appointment on April 18, my doctor switched me to Carvedilol (Dilatrend), which is now prescribed...

Dr. Lai Shuyi reply Pharmacology
1. Inderal (generic name Propranolol) belongs to the class of β-blockers and is approved by the health authorities for cardiac indications such as angina pectoris, arrhythmias (supraventricular arrhythmias, ventricular tachycardia), primary and renal hypertension, and the managem...

Understanding the Use of Bisoprolol for Mitral Valve Prolapse Symptoms

Hello, I have recently been experiencing sharp pains in my heart and chest tightness. The examination results indicated that I have mitral valve prolapse syndrome. Initially, the doctor prescribed Inderal, but I still felt somewhat uncomfortable, so the doctor switched me to Corl...

Dr. He Dongjin reply Cardiology
Hello, HBP-Smooth is not a medication for treating hypertension; it is only 30 mg. Generally, the treatment for blood pressure may require up to 180 mg. You can take it and compare its effects with Inderal without worrying. Ping An Changhua Hospital cares about you.

Alternatives to Carvedilol for Managing Hypertension and Gum Issues

If you are currently taking carvedilol (a beta-blocker) for hypertension but are experiencing issues with gum swelling and abscesses, there are alternative classes of antihypertensive medications that you could consider. For example, you might discuss with your healthcare provide...

Dr. Lin Wuxuan reply Internal Medicine
Hello: Regarding your question about antihypertensive medications, if there are adverse drug reactions that require adjustments, we will need your past medical history, medication history, and responses to the medications. Additionally, we will need to consider your physical exam...