--- title: Mirabegron is supposed to raise blood pressure. In 2,091 Korean patients, 8.8 percent saw a rise of 10 mmHg or more publication: Medical Insights Korea section: news category: Overactive Bladder canonical_url: https://medicalinsightskorea.com/news/korea-mirabegron-blood-pressure-2091-patients author: Andrew Cho published: 2026-10-21T09:00:00+09:00 modified: 2026-10-21T09:00:00+09:00 content_type: reporting license: Quotation permitted with attribution to Medical Insights Korea and a link to the canonical URL. --- # Mirabegron is supposed to raise blood pressure. In 2,091 Korean patients, 8.8 percent saw a rise of 10 mmHg or more 95 institutions, three months of treatment, and a set of thresholds rather than an average. 2.3 percent rose by 20 mmHg or more — which is the figure a hypertensive patient should be given. ## Answer In a retrospective multicentre observational study of 2,091 Korean adults with overactive bladder prescribed a generic prolonged-release mirabegron 50 mg once daily for at least three months across 95 medical institutions between July 2020 and July 2021, 8.8 percent had an increase in systolic blood pressure of 10 mmHg or more after three months, 3.7 percent an increase of 15 mmHg or more and 2.3 percent of 20 mmHg or more, while diastolic pressure rose by 5 mmHg or more in 16.8 percent and by 10 mmHg or more in 6.7 percent, with adverse events in 2.1 percent and mean medication coverage of 73.6 percent. ## Key takeaways - 2,091 Korean adults with overactive bladder were treated with prolonged-release mirabegron 50 mg daily for at least three months across 95 medical institutions. - Systolic blood pressure rose by 10 mmHg or more in 8.8 percent of patients after three months. - The rise reached 15 mmHg or more in 3.7 percent and 20 mmHg or more in 2.3 percent. - Diastolic pressure rose by 5 mmHg or more in 16.8 percent and by 10 mmHg or more in 6.7 percent. - Overall adverse event incidence was 2.1 percent, and the events were mostly mild. - Mean medication coverage — the share of the period actually covered by dispensed drug — was 73.6 percent. - Overactive bladder symptoms improved significantly in the subgroup for which symptom scores were available. ## Full article The blood pressure warning attached to mirabegron is the main reason clinicians hesitate over it, and it is usually communicated as a mean change of a few millimetres of mercury. A mean is the wrong shape for this question. Nobody is harmed by an average; they are harmed by being one of the people at the top of the distribution. ### Thresholds instead of an average **8.8% / 3.7% / 2.3%** — share of 2,091 Korean patients whose systolic blood pressure rose by 10, 15 and 20 mmHg or more after three months on mirabegron _Source: Lee JH et al., Investigative and Clinical Urology, 2026_ Reported this way the finding becomes usable. Roughly one patient in eleven will see a systolic rise of at least 10 mmHg, one in twenty-seven at least 15, and one in forty-three at least 20. The diastolic figures are higher at the lower threshold — 16.8 percent rose by 5 mmHg or more — and fall to 6.7 percent at 10 mmHg. The authors' summary is that there was no clinically meaningful increase in blood pressure, and across the cohort that is defensible. It is also the kind of statement that a patient with poorly controlled hypertension should not be handed without the distribution behind it, because the 2.3 percent is where the clinical decision actually lives. ### What has no control group here either This is retrospective and uncontrolled. Blood pressure measured at a clinic three months apart moves for reasons that have nothing to do with a bladder drug — season, time of day, cuff, white-coat effect, whether the patient walked in. Some proportion of the 8.8 percent is that noise. Without an untreated comparison group the study cannot say how much, and it does not claim to. > **Reading this against the anticholinergic alternative** > The reason mirabegron's blood pressure profile matters at all is that the drugs it replaces carry a different risk. A separate Korean analysis of patients aged 65 and over found that antimuscarinics generated 15 times the cumulative anticholinergic cognitive burden of patients without overactive bladder, with two-thirds of it attributable to the bladder drug, while mirabegron contributed none. The choice is not between a risky drug and a safe one. It is between a cognitive exposure in older patients and a cardiovascular one, and which matters more depends on the patient in front of you. ### The compliance number Mean medication coverage was 73.6 percent, meaning patients held dispensed drug for roughly three-quarters of the period they were nominally being treated. That is a quietly important figure for interpreting everything else in the study: a quarter of the exposure being measured did not happen, which pushes both the efficacy and the blood pressure findings towards the null. ## Sources - Lee JH, Kim A, Shim JS, Ko KJ. Blood pressure increases and other safety and medication compliance in overactive bladder patients treated with Selebeta PR tablets: A noninterventional, multicenter, retrospective observational study. Investigative and Clinical Urology 2026;67(3):273-280. doi:10.4111/icu.20250489. PMID:42065663. https://doi.org/10.4111/icu.20250489 - Lee KS, Cho J, Kang D, Ko KJ, Foo CY, Stoelzel M, Hadi FA, Kim S. A Retrospective Database Analysis of Anticholinergic Burden Among Older Patients With and Without Overactive Bladder in South Korea. International Neurourology Journal 2025;29(3):188-196. doi:10.5213/inj.2550112.056. PMID:41077792. https://doi.org/10.5213/inj.2550112.056 ## Citation Andrew Cho (2026). "Mirabegron is supposed to raise blood pressure. In 2,091 Korean patients, 8.8 percent saw a rise of 10 mmHg or more". Medical Insights Korea. https://medicalinsightskorea.com/news/korea-mirabegron-blood-pressure-2091-patients Retrieved from https://medicalinsightskorea.com/news/korea-mirabegron-blood-pressure-2091-patients