Selective beta-adrenergic blockers
ATC code: C07AB07 (Bisoprolol)
Highly selective beta-1 adrenergic receptor blocker. Reduces heart rate, cardiac output, and renin secretion. At therapeutic doses it has negligible effect on beta-2 receptors in bronchi and vasculature. In heart failure it reduces sympathoadrenal neurohormonal activation and improves myocardial remodeling.
First line
Beta-blockers are first-line rate control agents in atrial fibrillation per 2020. Bisoprolol is given to achieve a target resting HR below 110 bpm (lenient control) or below 80 bpm (strict control when indicated).
Ventricular rate control in atrial fibrillation.
First line
Beta-blockers are first-line anti-anginal therapy in stable angina. They reduce heart rate, myocardial oxygen demand, and angina frequency. Target resting heart rate is 55–60 bpm.
First line
Bisoprolol is one of three beta-blockers proven to reduce mortality in HFrEF (alongside carvedilol and metoprolol succinate). The CIBIS-II trial showed a 34 % reduction in all-cause mortality. Start at 1.25 mg daily, titrate every 2 weeks to target dose of 10 mg.
HFrEF (LVEF 40 % or below).
Individual decision
Beta-blockers as antihypertensive monotherapy in the absence of CAD, HF, tachyarrhythmia, or post-MI status are not first-line per 2024, 2017, and NG136. In younger patients without a compelling indication, ACEi/ARB, CCB, or thiazide-like diuretic is preferred. ESC/ESH 2024 explicitly notes that beta-blockers are less effective at stroke prevention than other classes. Bisoprolol as first-line antihypertensive is justified only in concurrent CAD, HF, AF, or tachyarrhythmia. Dose 5–10 mg once daily.
1 pair found. Sorted from critical to minor.
Mechanism
Аддитивная отрицательная хронотропия и инотропия. Риск брадикардии, AV-блокады и сердечной недостаточности.
Management
Сочетание избегать без явных показаний. При необходимости – минимальные дозы, ЭКГ-контроль.
FDA category C. Beta-blockers can cause fetal growth restriction and neonatal bradycardia. If antihypertensive therapy is needed in pregnancy, labetalol or methyldopa are preferred.
Excreted in breast milk. Risk to the infant at standard doses is considered low, but the neonate should be monitored for bradycardia.
bisoprolol is evaluated for the following indications with varying evidence strength: Coronary artery disease (evidence tier A), Atrial fibrillation (evidence tier A), Heart failure (evidence tier A). See the full indication matrix with dosing and citations above on this page.
Common side effects of bisoprolol (≥ 1 in 100): Bradycardia, Hypotension, Fatigue, weakness, Dizziness, Cold extremities. See the Safety section for uncommon and serious reactions.
FDA category C. FDA category C. Beta-blockers can cause fetal growth restriction and neonatal bradycardia. If antihypertensive therapy is needed in pregnancy, labetalol or methyldopa are preferred.
Excreted in breast milk. Risk to the infant at standard doses is considered low, but the neonate should be monitored for bradycardia.
bisoprolol is contraindicated in: Second- or third-degree AV block without a pacemaker; Sick sinus syndrome without a pacemaker; Severe bradycardia (HR below 50 bpm before treatment); Severe bronchial asthma or COPD with significant bronchospasm; Pheochromocytoma without prior alpha-blockade. Full list in the Safety section.