What is the difference between bisoprolol and metoprolol

For patients with uncomplicated hypertension beta-blockers are generally a fourth-line option as angiotensin converting enzyme ACE inhibitors, angiotensin II receptor blockers ARBs , diuretics or calcium channel blockers are associated with better outcomes. There is no evidence that one beta-blocker is superior to any other for the management of hypertension.

Information on the management of hypertension is available from: bpac. Beta-blockers are given acutely as first-line treatment post-myocardial infarction to decrease infarct size, increase the threshold for ventricular arrhythmias, and in the long-term, to prevent dysfunctional ventricular remodelling and heart failure.

At 6—months post-myocardial infarction prescribers are encouraged to consider withdrawing beta-blockers from patients without atrial fibrillation or heart failure, if re-vascularisation occurred while they were being treated for their myocardial infarction.

If re-vascularisation did not occur the beta-blocker is likely to be required long term to prevent angina or if there is poor ventricular function. This is an evolving area of research and increasingly the evidence appears to support the withdrawal of beta-blockers from patients without other indications for treatment, e.

Information on the management of acute coronary syndromes is available from: bpac. There are two reasons why the optimal duration of beta-blocker treatment post-myocardial infarction is uncertain: A systematic review of sixty trials that divided studies into either the reperfusion era or the pre-reperfusion era, found that beta-blockers reduced mortality in patients post-myocardial infarction in the pre-reperfusion era, but not the reperfusion era.

Guidelines support the use of a beta-blocker for one to three years post-myocardial infarction, 18, 19 but in practice they are now being stopped earlier in patients who are otherwise well, with no signs of angina or heart failure.

The adverse effect profile varies between beta-blockers according to their properties Table 1. Tolerance to treatment may be improved with a slow upward titration of the beta-blocker until the maintenance dose is established. Table 2 summarises recommended choices of beta-blocker, depending on the indication, patient co-morbidities and adverse effects. Beta-blockers should be started at a low dose and slowly titrated to maximum tolerated dose when used to treat patients with heart failure.

For other conditions, e. Refer to the New Zealand Formulary for individual beta-blocker dosing regimens: www.

Begin treatment with a beta-blocker at a low dose and gradually increase this to the recommended dose or the maximum tolerated dose. If adverse effects do not resolve, drop back to the previous dose and assess symptom control. Beta-blockers should generally be avoided in patients with asthma. If a beta-blocker must be used in a patient with asthma, cardioselective beta-blockers, e. There is evidence that beta-blockers are under-prescribed to patients with COPD, yet they provide significant benefit to those with co-existing heart failure; 23 cardioselective beta-blockers are preferred.

A systematic review which included 15 studies with a follow-up period ranging from one to seven years found that beta-blockers in patients with COPD significantly decreased overall mortality and exacerbation of COPD. Cardioselective beta-blockers, e. Malaise, vivid dreams, nightmares and in rare cases hallucinations may be caused by lipid-soluble beta-blockers crossing the blood brain barrier.

Table 2: Summary of indications, recommendations and considerations for the use of beta-blockers for cardiovascular conditions in New Zealand. All beta-blockers are considered to be equally effective although bisprolol or metoprolol may be preferred.

Celiprolol and pindolol tend not to be used. Celiprolol and pindolol have ISA which may reduce bradycardia or peripheral vasoconstriction. Water soluble beta-blockers, e. Polypharmacy: bisoprolol is less likely to interact with other medicines. Renal dysfunction: consider dose adjustments for water-soluble beta-blockers, e. Respiratory disease: cardioselective beta-blockers, e.

Bisoprolol or metoprolol; consider withdrawal after 6—12 months if re-vascularised and no other indications. Treatment with beta-blockers is generally long-term, but it should not be regarded as indefinite. Occasionally it may be necessary to temporarily withdraw treatment, e. In the long-term, the emergence of co-morbidities may make management more complex and it is appropriate to periodically review the benefits and risks of treatment with beta-blockers.

Beta-blockers should be withdrawn slowly to prevent the onset of a withdrawal syndrome which in serious cases may include ischaemic cardiac symptoms, e. The risk of myocardial infarction is increased for older patients during the first month of withdrawal from cardioselective beta-blockers and this increased risk continues for six months. There are no specific guidelines for withdrawing beta-blockers. The dose could be halved every week for patients who needed to withdraw from treatment more rapidly.

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Cardiovascular system Medicine indications Pharmacology. Beta-blockers for cardiovascular conditions: one size does not fit all patients Metoprolol succinate accounts for almost three-quarters of the beta-blockers dispensed in New Zealand. Multicentre, parallel group, open labelled, randomised noninferiority trial was conducted at 6 cardiology centres in India — The study was approved by the institutional ethics committee at each centre and was performed in accordance with the good clinical practice guidelines and ICH-GCP.

Out adult patients screened, patients between the age group of 18 to 65 years, with systolic blood pressure SBP — mm Hg or diastolic blood pressure DBP 90—99 mm Hg were randomly assigned to receive either Bisoprolol 5 mg once daily or Metoprolol-SR 50 mg once daily.

Efficacy analysis was done on patients who completed the study. There was a trend towards a better 24 hr BP control rate with Bisoprolol, responder rates were Also Bisoprolol was non-inferior to Metoprolol with respect to percentage of patients requiring dose titration Our study supports the use of bisoprolol in Indian patients, based on the non-inferiority as compared to metoprolol and with the advantageous profile of the molecule. Type of funding sources: Private company.

Main funding source s : The study was supported by a research grant from Merck. Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide. Sign In or Create an Account. Sign In. Advanced Search. Search Menu. Article Navigation. Close mobile search navigation Article Navigation. Volume Article Contents Abstract.

The first nighttime blood pressure monitoring was used as baseline. The difference between the mean ambulatory nighttime blood pressure observed at Week 12 and baseline was calculated to find out the change of mean ambulatory nighttime blood pressure at the end of the treatment. Nighttime in this study was defined as pm to am. The first measured daytime heart rate was used as baseline heart rate. The difference between the daytime heart rate at Week 12 treatment and of the baseline heart rate was calculated to measure the change of mean ambulatory daytime heart rate at the end of the treatment.

Daytime in this study was defined as am to pm. The difference between the nighttime heart rate at Week 12 treatment and of the baseline heart rate was calculated to measure the change of mean ambulatory nighttime heart rate at the end of the treatment.

Nighttime was defined as pm to am. The mean change in the blood pressure variability between the hour blood pressure observed at Week 12 and baseline was calculated. Blood pressure response rate was calculated as: number of subjects with blood pressure response divided by total number of subjects and multiplied by Heart rate response rate was calculated by using the number of subjects with heart rate response divided by total number of subjects and multiplied by The difference between the last 24 hours heart rate at Week 12 and of the baseline heart rate was calculated.

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Search for terms. Save this study. Warning You have reached the maximum number of saved studies Listing a study does not mean it has been evaluated by the U. Federal Government. Read our disclaimer for details. Results First Posted : May 13, Last Update Posted : May 13,