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