膀胱過動症治療中 Mirabegron 相關的高血壓問題

蘇文彬¹、林大鈞²、陳曉芳²、蕭亞芝²、鄭如惠³、蔡蔓綺⁴、黃品叡⁵

1李綜合醫療社團法人苑裡李綜合醫院 醫療部 專科護理師小組

2李綜合醫療社團法人大甲李綜合醫院 醫療部 專科護理師小組

3李綜合醫療社團法人苑裡李綜合醫院 護理部

4疾病管制署中區管制中心 檢疫科

5李綜合醫療社團法人大甲李綜合醫院 外科部 泌尿外科

Mirabegron-Associated Hypertension in Overactive Bladder Management

Wen-Pin Su ¹, Ta-Chun Lin², Hsiao-Fang Chen², Ya-Chih Hsiao², Ru-Hui Cheng³, Man-Chi Tsai⁴,
Pin-Jui Huang⁵

1Division of Nursing Participants, Department of Medical Affairs, Yuanli Lee Hospital

2Division of Nursing Participants, Department of Medical Affairs, Dajia Lee Hospital

3Nursing Department, Yuanli Lee Hospital

4Quarantine Department, Central Regional Center, Centers for Disease Control, Ministry of Health and Welfare

5Division of Urology, Department of Surgery, Dajia Lee Hospital

Background:

Mirabegron, a selective β3-adrenoceptor agonist, has become an important therapeutic option for patients with overactive bladder (OAB), particularly for those intolerant to antimuscarinic agents. While its efficacy and favorable adverse-effect profile are well established, growing evidence suggests that mirabegron may elevate blood pressure (BP) through β-adrenergic stimulation of vascular smooth muscle. Hypertension has therefore emerged as a clinically relevant safety concern, especially among older adults and patients with cardiovascular comorbidities. This review summarizes the current evidence on mirabegron-related BP elevation and provides practical recommendations for urologists.

Methods:

A comprehensive literature search was conducted using PubMed, Scopus, and Web of Science with the terms “mirabegron,” “overactive bladder,” “hypertension,” and “cardiovascular safety.” Studies published from 2013 to 2025 were included if they reported BP outcomes, cardiovascular adverse events, or safety assessments related to mirabegron use in adult OAB patients. Randomized controlled trials, real-world cohort studies, and post-marketing surveillance reports were reviewed.

Results:

Across phase II–III clinical trials, mirabegron produced small but consistent mean increases in systolic and diastolic BP (approximately 1–3 mmHg). Although the incidence of clinically significant hypertension was low, most trials excluded patients with uncontrolled hypertension, limiting the generalizability of these findings. Post-marketing data, including pharmacovigilance reporting systems, have documented cases of notable BP elevation, hypertensive urgency, and exacerbation of pre-existing hypertension, predominantly in older patients with multiple comorbidities. Real-world observational studies confirm that mirabegron is generally safe in individuals with well-controlled BP but may pose meaningful risks in those with stage 2 or labile hypertension.

Discussion:

Mirabegron-induced BP elevation is typically mild, but susceptible patients may experience substantial increases requiring dose adjustment or discontinuation. Risk factors include advanced age, pre-existing hypertension, polypharmacy, and underlying cardiovascular disease. A structured assessment of baseline BP, cardiovascular history, concomitant medications, and target-organ involvement should be performed before initiating therapy. For appropriate candidates, early BP monitoring during the first 4–8 weeks enhances safety and allows timely intervention.

Conclusion:

Mirabegron remains an effective and generally safe OAB therapy; however, its potential to increase BP warrants careful patient selection and monitoring. In patients with uncontrolled or severe hypertension, alternative treatments—such as optimized antimuscarinics, behavioral therapy, pelvic floor training, or intravesical botulinum toxin—should be prioritized. Further real-world studies focusing on high-risk populations are needed to better clarify cardiovascular safety and refine clinical guidelines.