Bisoprolol (Cardiorenal Syndrome / CKD)

How it works

It selectively blocks beta-1-adrenoceptors, reducing heart rate, myocardial contractility and renin release, which improves outcomes in chronic heart failure when titrated slowly.

Prescribing in practice

• In heart failure it must be started at a low dose and uptitrated gradually when the patient is stable, as abrupt initiation or withdrawal can precipitate decompensation.
• Bisoprolol is partly renally cleared, so cautious dosing is appropriate in significant renal impairment, watching for bradycardia and hypotension.
• Use caution combining with other rate-limiting agents and monitor potassium when used alongside renin-angiotensin and aldosterone blockade common in cardiorenal disease.

Monitoring

Monitor heart rate, blood pressure, fluid status and renal function, particularly during dose titration.

Counselling the patient

• Do not stop the tablets suddenly; any reduction should be gradual and supervised.
• Report marked dizziness, a very slow pulse or worsening breathlessness or swelling.
• Initial tiredness often improves as your body adjusts.

Evidence & guidelines

Gradual beta-blocker titration in heart failure with reduced ejection fraction is supported by the CIBIS-II trial and NICE chronic heart failure guidance.