Moderate
Bisoprolol × Budesonide
Selective beta-adrenergic blockers×Inhaled corticosteroids (ICS)
Mechanism
Systemic (oral) budesonide causes sodium retention and weakens the antihypertensive effect of the beta-blocker. With inhaled use, systemic effect is minimal, so no clinical impact.
Symptoms
Gradual blood pressure rise 2–4 weeks after starting the glucocorticoid. In heart failure: oedema, weight gain.
Management
Inhaled budesonide for asthma or COPD does not require bisoprolol adjustment. For oral therapy in inflammatory bowel disease, check blood pressure every 2–4 weeks.