TRANSLATIONAL AND CLINICAL MEDICINE - Georgian Medical Journal

Background: Hypertension, a prevalent global health issue affecting approximately two-thirds of the adult population, significantly elevates the risk of cardiovascular morbidities, including ischemic heart disease, stroke, and heart failure, ultimately contributing to increased mortality rates. Resistant hypertension (RHTN), characterized by persistent blood pressure elevation despite adherence to a regimen of at least three antihypertensive agents, affects an estimated 10% of hypertensive individuals. Current clinical guidelines advocate for the addition of a fourth antihypertensive agent, such as a beta-blocker, in the management of RHTN. However, the evidence base supporting the efficacy of beta-blockers in this specific population remains limited. The PATHWAY-2 study, a key investigation in this area, demonstrated that bisoprolol, a second-generation beta-blocker, conferred a modest reduction in systolic blood pressure (8.4 mmHg). Notably, there is a paucity of data regarding the comparative effectiveness of other beta-blockers, particularly third-generation agents possessing vasodilator  properties, on both systolic and diastolic blood pressure outcomes in patient with RHTN.
Aim: The addition of carvedilol, a third-generation beta-blocker with vasodilator properties, would help achieve blood pressure targets (<130/80 mmHg) in patient with RHTN.
Methods: Patient with confirmed RHTN, defined as uncontrolled blood pressure (>140/90 mmHg) as measured by 24-hour ambulatory blood pressure monitoring. Carvedilol was added to the existing antihypertensive regimen. The primary outcome measures were changes in systolic and diastolic blood pressure following 6 weeks of carvedilol treatment.
Results: The addition of carvedilol resulted in a significant reduction in both systolic and diastolic blood pressure and achieved target blood pressure.
Conclusion: The results of this clinical case suggest that carvedilol is an effective therapeutic option for the treatment of RHTN. Further research is warranted to confirm these finding and to elucidate the underlying mechanisms responsible for the observed effects.

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