The Treatment Response and Safety Profile for Mirabegron in Women With Overactive Bladder and Hypertension

Abstract

Background and objective Mirabegron, an established treatment for overactive bladder (OAB), is contraindicated in patients with uncontrolled hypertension. Inevitably, there is concern among clinicians and patients regarding its use in patients with well-controlled hypertension. In this study, we aimed to investigate the efficacy of mirabegron in patients with well-controlled hypertension, as well as its adverse effects. Methods This retrospective study involved women with well-controlled hypertension who used mirabegron for the treatment of OAB between August 1, 2017, to July 31, 2020. Medical notes were reviewed from the time of initiation of mirabegron up to 12 months post-treatment. The indicators of response measured were frequency of maturation and nocturia. The sense of urgency and urge incontinence were assessed as well. Safety of the drug was evaluated by documenting the number of hypertensive episodes and recording side effects such as dry mouth, dry eyes, headache, and rashes. Results Forty-six patients with OAB and hypertension were included in the study. Of them, 38 patients (73.6%) had improvement in OAB symptoms following mirabegron therapy. Median urinary frequency improved from 1.5 hours to two hours after mirabegron treatment. Twenty-three of the patients stopped experiencing nocturia one month after starting mirabegron. Sixteen patients (76.2%) experienced improvement in urge symptoms while 19 patients (86.4%) experienced improvement in urge incontinence. Of note, 38 patients (78.2%) did not experience any side effects at all, while a small proportion of the patients (n=4, 8.7%) experienced anticholinergic side effects. Three patients (6.5%) experienced an increase in blood pressure after mirabegron use; no additional anti-hypertensive agents were used as mirabegron was stopped once an increase in blood pressure was noted. Conclusions Mirabegron is efficacious in improving OAB symptoms. It is well tolerated by hypertensive patients and may be used in the long term for symptom control. Home blood pressure monitoring may aid in the earlier detection of worsening control in the small segment of patients in whom mirabegron is not suitable.

Keywords: beta-3-agonist; bladder training; hypertensive patients; menopause; mirabegron; mixed urinary incontinence; overactive bladder; stress urinary incontinence; urge urinary incontinence; β3-adrenergic receptor agonist.

Figure 1. Patient selection process

Figure 2. Patients who experienced symptoms of urgency, urgency incontinence, and stress incontinence