Expert perspectives on the role of beta-blockers in managing hypertension and associated disease risk factors in Indian settings

Objective: To gather expert perspectives on the role of beta-blockers, particularly bisoprolol, in the management of hypertension and associated disease risk factors in Indian settings. Methodology: This cross-sectional study was carried out among clinicians specialized in managing hypertension and associated cardiovascular risk factors. A 23-item, multiple-response questionnaire was utilized to gather feedback, clinical observations, and experiences with beta-blockers in hypertension management. The data were analyzed using descriptive statistics. Results: The study involved 504 clinicians. Bisoprolol was the preferred beta-blocker, reported by 56% of clinicians, while 40% favored metoprolol. The majority (75.79%) observed a definite improvement in blood pressure (BP) with bisoprolol. More than half (54.56%) stated that 25 to 50% of patients required two antihypertensive drugs. According to 98% of clinicians, telmisartan was the preferred angiotensin receptor blocker (ARB) to pair with bisoprolol. A combination of an ARB and a beta-blocker was preferred by 63% for young patients with newly diagnosed hypertension, those with increased cardiovascular risk, and those with uncontrolled hypertension. The telmisartan + bisoprolol fixed-dose combination (FDC) was preferred for hypertension with cardiac, respiratory, renal complications, and diabetes, as reported by 57% of experts. Around 44% stated that an ARB + beta-blocker combination was used in 21 to 30% of hypertensive patients with diabetes. Bisoprolol was the preferred beta-blocker in patients with respiratory conditions, as reported by 82%. Additionally, 72% of experts favored telmisartan + bisoprolol as the preferred combination for hypertension with cardiac complications. Conclusion: This study highlights clinicians' preference for bisoprolol in hypertension management in Indian settings, citing significant BP improvements and good tolerability, even in patients with respiratory and cardiac comorbidities. The strong preference for bisoprolol with telmisartan reflects its complementary action and cardiovascular benefits, especially in complex cases, indicating an evidence-based, patient-centered approach.