Effects of bisoprolol on lipoprotein cholesterol subfractions and apolipoproteins in patients with hypertension

Non-selective beta-blockers tend to increase triglycerides and low-density lipoprotein (LDL) cholesterol while decreasing the atheroprotective high-density lipoprotein (HDL) cholesterol, particularly the HDL2 cholesterol subfraction. The aim of this study was to investigate whether the highly beta1-selective beta-blocker bisoprolol shares with non-selective beta-blockers these effects on blood lipids in patients treated for mild or moderate essential hypertension. In particular, HDL cholesterol and its subfractions HDL2 cholesterol and HDL3 cholesterol as well as apolipoproteins A1 and B were investigated. In a multicentre outpatient trial, 86 hypertensive patients received bisoprolol for eight weeks. Diastolic blood pressure was reduced from a baseline of 102 ± 7 mmHg (mean ± SD) to 87 ± 8 mmHg after 8 weeks of therapy with bisoprolol. Systolic blood pressure decreased from 159 ± 17 mmHg to 139 ± 14 mmHg. Blood pressure was normalized in 69 % of patients with 5 mg bisoprolol once daily and, after increasing the dosage to 10 mg bisoprolol once daily in non-responders, in 80 % of patients. Treatment with bisoprolol decreased triglycerides by 4.8 % and LDL cholesterol by 1.7 %, whereas HDL cholesterol increased by 5.2 %, which was attributable to an increase by 9.2 % of HDL2 cholesterol and by 3.0 % of HDL3 cholesterol, respectively. None of these single changes were significant at the p 0.05 level. Surprisingly, however, all lipid effects were in the favourable direction and opposite to the changes usually observed with non-selective beta-blockers. In a mathematical model derived from angiographic studies, the improvement of lipid risk factors brought about by bisoprolol equalled that of a decrease in age by 3.5 years. We thus conclude that effective antihypertensive doses of bisoprolol do not exert the typical dyslipidaemic effects of beta-blockers but rather tend to induce small but favourable changes in plasma triglycerides, LDL and HDL cholesterol, and especially in the atheroprotective HDL2 cholesterol ...