Moderate
Bisoprolol × Dexamethasone
Selective beta-adrenergic blockers×Glucocorticoids
Mechanism
Dexamethasone causes sodium and water retention via mineralocorticoid effect, reducing the antihypertensive effect of the beta-blocker.
Symptoms
Gradual blood pressure rise 2–4 weeks after starting the glucocorticoid. In heart failure: oedema, weight gain.
Management
For short dexamethasone courses (up to 7 days), no adjustment. For prolonged systemic therapy, increase bisoprolol or add a diuretic (hydrochlorothiazide, indapamide) with blood pressure monitoring.