Key result
A resting heart rate of 70-74 beats/min in bisoprolol-treated CAD patients with hypertension was associated with a higher risk of composite cardiac clinical outcomes (adj OR 4.34; 95% CI 1.19-15.89).
Why the study?
Resting heart rate strongly predicts mortality and heart failure hospitalization in hypertension, but the prognostic impact of resting heart rate changes in bisoprolol-treated CAD patients with comorbid hypertension required evaluation.
Does resting heart rate control with bisoprolol improve composite cardiac clinical outcomes in Asian CAD patients with comorbid hypertension?
Observational (n=681)
Yes
Does resting heart rate control with bisoprolol improve composite cardiac clinical outcomes in Asian CAD patients with comorbid hypertension?
In Asian CAD patients with hypertension, achieving a lower resting heart rate with bisoprolol is associated with improved composite cardiac clinical outcomes.
Answers are grounded in this paper and cite their sources.
RHR 70-74 bpm was associated with higher risk in bisoprolol-treated CAD patients; leaves open optimal targets for prospective confirmation.
BACKGROUND: Resting heart rate (RHR) is considered as a strong predictor of total mortality and hospitalization due to heart failure in hypertension patients. Bisoprolol fumarate, a second-generation beta-adrenoreceptor blockers (β-blocker) is commonly prescribed drug to manage hypertension. The present study was to retrospectively evaluate changes in the average RHR and its association with cardiovascular outcomes in bisoprolol-treated coronary artery disease (CAD) patients from the CAD treated with bisoprolol (BISO-CAD) study who had comorbid hypertension. METHODS: We performed ad-hoc analysis for hypertension sub-group of the BISO-CAD study (n = 866), which was a phase IV, multination, multi-center, single-arm, observational study carried out from October 2011 to July 2015 across China, South Korea, and Vietnam. Multivariate regression analysis was used to identify factors associated with incidence of composite cardiac clinical outcome (CCCO), the results were presented as adjusted odds ratio (OR) along with 95% confidence interval (CI) and adjusted P value. RESULTS: A total of 681 patients (mean age: 64.77 ± 10.33 years) with hypertension from BISO-CAD study were included in the analysis. Bisoprolol improved CCCOs in CAD patients with comorbid hypertension, with RHR <65 and <70 beats/min compared with RHR ≥65 and ≥75 beats/min, respectively, in the efficacy analysis (EA) set. In addition, it lowered RHR in both intent-to-treat (ITT) and EA groups after 6, 12, and 18 months of treatment. Further, RHR 70 to 74 beats/min resulted in significantly higher risk of CCCOs EA set of patients (adjusted OR: 4.34; 95% CI: 1.19-15.89; P = 0.03). Also, events of hospitalization due to acute coronary syndrome were higher when RHR 69 to 74 beats/min compared to RHR <69 beats/min in ITT patients. CONCLUSION: Bisoprolol can effectively reduce RHR in Asian CAD patients with comorbid hypertension and hence, improve CCCO without affecting their blood pressure.
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Chen et al. (2020) conducted an observational in Coronary artery disease with comorbid hypertension (n=681). Resting heart rate 70 to 74 beats/min vs. Other resting heart rates was evaluated on Composite cardiac clinical outcome (CCCO) (adjusted OR 4.34, 95% CI 1.19-15.89, p=0.03). A resting heart rate of 70-74 beats/min in bisoprolol-treated CAD patients with hypertension was associated with a higher risk of composite cardiac clinical outcomes (adj OR 4.34; 95% CI 1.19-15.89).
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