Key result
Bisoprolol stands out among second-line hypertension therapies given its high beta1-selectivity and rare side effects.
Why the study?
Recent hypertension guidelines demoted beta-blockers to second-line therapy and evidence suggests potential harm in HFpEF and stable coronary heart disease, prompting a review of their current role.
This review summarizes current data on beta-blockers in cardiovascular disease, emphasizing their changing role in hypertension guidelines and the specific profile of bisoprolol.
Supports beta-blockers as second-line hypertension therapy favoring bisoprolol; leaves open need for updated RCTs.
Beta-blockers are used to treat various cardiovascular diseases, including hypertension and chronic heart failure. They act by suppressing the effects of catecholamines through various pathways and affect heart rate, strength, and renin release, providing antihypertensive and anti-ischemic effects. The individual effects of various drugs on clinical outcomes in this group were determined according to characteristics of the patient, underlying disease, and type of beta-blocker used. In recent years, beta-blockers have faced a serious obstacle when new guidelines on hypertension suggest their use as second-line therapy after angiotensin converting enzyme inhibitors, angiotensin receptor blockers and slow calcium channel blockers in the absence of clear indications. In fact, these recommendations were based on meta-analyses that showed that beta-blockers have fewer beneficial effects on overall mortality, cardiovascular events, and brain stroke. In addition, according to currently available data, the appointment of beta-blockers for diseases such as heart failure with preserved ejection fraction and stable coronary heart disease can cause more harm than good outcomes. Bisoprolol is a beta-blocker with the highest selectivity for beta1-adrenergic receptors, which determines the rare frequency of side effects that develop because of its use. This review presents current data on the use of beta-blockers for treating cardiovascular diseases, with an emphasis on the use of bisoprolol.
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Чулков et al. (2024) conducted a review in Cardiovascular diseases. Beta-blockers (bisoprolol) was evaluated. Beta-blockers are currently recommended as second-line therapy for hypertension, while bisoprolol is highlighted for its high beta1-selectivity and rare frequency of side effects.
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