Bisoprolol (Heart Failure in Elderly)

How it works

By selectively blocking cardiac beta-1 adrenoceptors it counters chronic sympathetic overactivity in heart failure, reducing heart rate and myocardial workload and improving long-term cardiac function and survival.

Prescribing in practice

• Start only when the patient is clinically stable, begin at a low dose and up-titrate slowly, as abrupt initiation or rapid escalation can transiently worsen heart failure; never stop abruptly.
• In older patients monitor closely for bradycardia, hypotension, fatigue and fluid retention during titration, and avoid in significant conduction block, decompensated failure or severe asthma.
• Use caution when combined with other rate-limiting drugs and watch for blunting of hypoglycaemia warning signs in diabetes.

Monitoring

Monitor heart rate, blood pressure, symptoms and signs of fluid status and weight at each up-titration step and during dose changes.

Counselling the patient

• Never stop the medicine suddenly; any changes should be made by your clinician.
• Some tiredness early on usually settles as the dose is increased.
• Report increasing breathlessness, swelling, weight gain, or a very slow pulse or dizziness.

Evidence & guidelines

Mortality benefit of bisoprolol in heart failure was established by the CIBIS-II trial and is reflected in NICE and ESC heart-failure guidance.