Switching from Bisoprolol to Another Antihypertensive

Critical Safety Considerations

• The American College of Cardiology recommends avoiding abrupt cessation of bisoprolol and other beta-blockers to prevent serious risks, including exacerbation of angina pectoris, myocardial infarction, or ventricular arrhythmia in patients with coronary artery disease 1

Preferred Replacement Options for Hypertension

• The American College of Cardiology recommends first-line alternatives, including thiazide diuretics, ACE inhibitors, ARBs, or calcium channel blockers, as beta-blockers are not recommended as first-line agents for hypertension unless the patient has ischemic heart disease or heart failure 1
• Dihydropyridine calcium channel blockers, such as amlodipine, provide complementary vasodilation and can be started during the bisoprolol taper, according to Praxis Medical Insights 2
• Thiazide-like diuretics, such as chlorthalidone or hydrochlorothiazide, are effective alternatives, as stated by Praxis Medical Insights 2

Special Clinical Contexts

• The American College of Cardiology strongly recommends continuing beta-blocker therapy in patients with coronary artery disease or prior MI to prevent rebound hypertension and tachycardia 3, 4