Bisoprolol beta blocker
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Summary
10 papers analyzed
These studies suggest bisoprolol is effective in reducing mortality, blood pressure, and heart rate in heart failure and hypertensive patients, with a favorable side-effect profile, but its safety and efficacy in severe cases and specific conditions like COPD and perioperative settings remain unclear.
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Beta20 papers analyzed
Bisoprolol Beta Blocker: Efficacy and Safety in Various Clinical Contexts
Bisoprolol in Heart Failure: Functional and Survival Benefits
Functional Improvement in Heart Failure
Bisoprolol, a beta1-selective beta-blocker, has shown significant functional benefits in patients with chronic heart failure. The Cardiac Insufficiency Bisoprolol Study (CIBIS) demonstrated that bisoprolol significantly improved the functional status of patients with severe heart failure, reducing the need for hospitalization due to cardiac decompensation and improving New York Heart Association (NYHA) functional class. These findings were further supported by the CIBIS-II trial, which showed that bisoprolol significantly reduced all-cause mortality and sudden deaths in heart failure patients, indicating a clear survival benefit.
Survival Benefits in Heart Failure
The CIBIS-II trial provided robust evidence that bisoprolol significantly decreases all-cause mortality in patients with chronic heart failure. The trial was stopped early due to the significant mortality benefit observed, with a hazard ratio of 0.66 for all-cause mortality and 0.56 for sudden deaths, highlighting the efficacy of bisoprolol in improving survival outcomes.
Bisoprolol in Hypertension: Efficacy and Safety
Antihypertensive Effects
Bisoprolol has been shown to be effective in controlling blood pressure in patients with mild to moderate hypertension. A study involving 240 hypertensive patients demonstrated that once-daily bisoprolol significantly reduced both systolic and diastolic blood pressure over a 24-hour period, with dose-related antihypertensive effects sustained throughout the dosing interval. This makes bisoprolol a reliable option for long-term blood pressure management.
Comparison with Other Beta-Blockers
In a randomized crossover trial comparing bisoprolol with other beta-blockers like carvedilol and metoprolol in patients with chronic heart failure and chronic obstructive pulmonary disease (COPD), bisoprolol was found to have a favorable profile in terms of respiratory function. It caused less bronchial beta-adrenoceptor blockade compared to nonselective beta-blockers like propranolol, making it a safer option for patients with coexistent COPD .
Bisoprolol in Perioperative Settings
Reduction of Perioperative Cardiac Events
Bisoprolol has also been evaluated for its effectiveness in reducing perioperative cardiac events in intermediate-risk patients undergoing noncardiovascular surgery. The DECREASE-IV trial found that bisoprolol significantly reduced the incidence of perioperative cardiac death and nonfatal myocardial infarction, demonstrating its protective effects in the perioperative setting.
Safety in Spinal Anesthesia
However, in the context of surgery with spinal block, bisoprolol did not show a significant impact on cardiovascular outcomes over a one-year follow-up period. The Swiss Beta Blocker in Spinal Anesthesia (BBSA) study indicated that perioperative bisoprolol therapy did not affect the composite outcome of cardiovascular mortality and morbidity, suggesting that its benefits may be context-specific.
Bisoprolol in Pulmonary Arterial Hypertension
Limited Efficacy in iPAH
In patients with idiopathic pulmonary arterial hypertension (iPAH), bisoprolol did not demonstrate significant benefits. A study found that while bisoprolol reduced heart rate, it did not improve right ventricular ejection fraction (RVEF) and was associated with a decrease in cardiac index and 6-minute walking distance, indicating a potential deterioration in cardiac function. This suggests that bisoprolol may not be suitable for iPAH patients.
Conclusion
Bisoprolol is a highly effective beta1-selective beta-blocker with proven benefits in improving functional status and survival in heart failure patients, as well as controlling blood pressure in hypertensive patients. Its safety profile is favorable, particularly in patients with coexistent COPD. However, its efficacy in reducing perioperative cardiac events may vary depending on the surgical context, and it appears to offer limited benefits in patients with idiopathic pulmonary arterial hypertension. These findings underscore the importance of patient-specific considerations when prescribing bisoprolol.
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