OBJECTIVES: The objective was to evaluate the clinical efficacy of bisoprolol compared to atenolol in reducing the in-clinic and ambulatory blood pressure in patients with mild to moderate hypertension. METHODS:  Studies were retrieved from Embase, Pubmed, and Cochrane databases using relevant search strategies. Randomised controlled trials which compared bisoprolol with atenolol were included according to pre-specified inclusion/exclusion criteria. The outcomes of interest were reduction in in-clinic systolic/diastolic blood pressure, 24-hour ambulatory BP (ABP), and reduction in heart rate. Two reviewers independently extracted data from the included studies. Data was meta-analysed using RevMan (v5). RESULTS:  Of the 1056 studies identified, 11 studies met the inclusion criteria. In total, 624 patients were randomised to bisoprolol, and 683 were randomised to atenolol. Seven of the included studies were double-blind, three were single-blind and one was open-label study. The Jadad score of eight studies was ≥3 and were of high quality. The study duration of included studies ranged from 8-weeks to 52-weeks. Results of meta-analysis showed a significantly better reduction of clinical systolic BP with bisoprolol compared to atenolol (WMD: 3.07 (1.79, 4.35, p<0.00001). The reduction in clinical diastolic BP was significantly better with bisoprolol compared to atenolol (2.68 (1.88, 3.48, p<0.00001). The systolic ABP was significantly reduced with bisoprolol compared to atenolol (p<0.001). The reduction in diastolic ABP was more with bisoprolol but was not significantly better. A significantly better reduction in heart rate was achieved with bisoprolol compared to atenolol (1.81 (0.97, 2.65, p<0.0001). CONCLUSIONS:  This review has included the evidence to date with regards to reduction of clinical and ambulatory blood pressure with bisoprolol compared to atenolol. This review concludes that bisoprolol is significantly better than atenolol in effectively reducing the in-clinic BP, ambulatory BP and heart rate in patients with mild to moderate essential hypertension.