Bisoprolol 10mg tablets

Cardiovascular diseases, such as hypertension, coronary artery diseases (CAD), arrhythmias, and chronic heart failure (CHF), often require treatment with beta-blockers. These conditions frequently coexist with chronic obstructive pulmonary disease (COPD), which can complicate therapeutic decisions. Indeed, patients with moderate-to-severe COPD are frequently not given these agents out of concern for possible bronchoconstriction arising from blockade of β2-adrenoceptors in the airways. Observational studies, and meta-analyses support the cardiovascular benefits of β-blockade in people with COPD and cardiovascular diseases. Recent trials evaluating cardioselective β-blockade suggest that cardioselective beta-blockers such as bisoprolol, metoprolol and nebivolol are safe and likely beneficial in those patients that would benefit from their intake due to presence of cardiac comorbid diseases. The aim of this systematic review is to summarise the recent trials and indications for use of cardioselective β-blockers in patients with COPD.

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ObjectiveThis study aimed to systematically evaluate the efficacy of beta-blockers (BBs) in preventing left ventricular dysfunction (LVD) induced by anthracyclines and trastuzumab. It combines traditional meta-analysis with Bayesian network meta-analysis (NMA) to compare the cardiac protective effects of different BBs.MethodsWe conducted a systematic literature search in databases such as PubMed, Web of Science, EMBASE, and the Cochrane Library to identify eligible randomized controlled trials (RCTs). Traditional meta-analysis and Bayesian NMA were used to evaluate the impact of BBs on left ventricular ejection fraction (LVEF) and cancer therapy-related cardiotoxicity events (CTRCE). The cumulative ranking probabilities (SUCRA) were used to rank the efficacy of different BBs. Data analysis was performed using STATA 16.0 and R 4.5.0 software.ResultsA total of 19 RCTs were included for LVEF outcomes and 15 for CTRCE outcomes. For LVEF, BBs were superior to controls overall (WMD = 2.19, 95% CI 1.40-2.98; I 2 = 93.5%). Subgroup analysis indicated consistent and greater improvement with bisoprolol and carvedilol. NMA-SUCRA ranking: bisoprolol 0.7696, carvedilol 0.6822, nebivolol 0.6023, metoprolol 0.2413, placebo 0.2047. For CTRCEs, BBs significantly reduced event risk (RR = 0.54, 95% CI 0.44-0.67; I 2 = 41.4%). Subgroup analyses showed benefit with bisoprolol (RR = 0.28, 0.15-0.50), nebivolol (RR = 0.48, 0.27-0.86), and carvedilol (RR = 0.68, 0.53-0.87), while metoprolol did not reach significance (RR = 0.33, 0.07-1.56). Treatment-specific subgroups revealed significant benefit in anthracycline (RR = 0.52, 0.37-0.74) and combination regimens (RR = 0.58, 0.45-0.79), but not in trastuzumab monotherapy (RR = 0.16, 0.02-1.26). NMA-SUCRA ranking: bisoprolol 0.8085, metoprolol 0.7303, nebivolol 0.5124, carvedilol 0.3743, placebo 0.0745.ConclusionBBs demonstrated robust protective effects in maintaining LVEF and reducing CTRCE risk, with bisoprolol showing the greatest efficacy, followed by carvedilol. The evidence supports prioritizing BBs during chemotherapy with individualized selection based on treatment regimen and patient profile. However, large-scale, multicenter RCTs with long-term follow-up are warranted to confirm long-term benefits and to explore combination strategies with other cardioprotective agents.Systematic review registrationidentifier CRD420251233424.

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BackgroundAnthracycline-based chemotherapy is a cornerstone in breast cancer treatment but is associated with cardiotoxicity, including subclinical cardiac damage. This study evaluates the efficacy of ramipril and bisoprolol in preventing subclinical cardiac impairment in patients with nonmetastatic breast cancer undergoing anthracycline-based chemotherapy.Patients and methodsThe SAFE trial is a multicenter, 2 × 2 factorial, randomized, placebo-controlled, double-blind study involving 262 patients. Participants were allocated to one of four groups: placebo-placebo, ramipril-placebo, bisoprolol-placebo, or ramipril-bisoprolol, administered concurrently with chemotherapy. Subclinical cardiac damage was assessed at 24 months using echocardiographic measures, specifically a ≥10% reduction in three-dimensional left ventricular ejection fraction (3D-LVEF) or global longitudinal strain (GLS).ResultsAt 24 months, patients receiving ramipril, bisoprolol, or their combination experienced significantly smaller declines in 3D-LVEF compared with placebo (-2.1%, -2.2%, and -3.4%, respectively; all P ConclusionsRamipril and bisoprolol significantly reduce the incidence of subclinical cardiac damage in patients with breast cancer undergoing anthracycline-based chemotherapy, thus supporting their use as early prevention cardioprotective strategies.

Abstract licence: CC BY-NC-ND