RHR lowering with bisoprolol tied to improved cardiac outcomes in Asian patients
Lowering of resting heart rate (RHR) with bisoprolol was associated with improved composite cardiac clinical outcome (CCCO) in Asian patients who had coronary artery disease (CAD) with comorbid hypertension, according to a subgroup analysis of the BISO-CAD study presented at ACC Asia 2018 in Shanghai, China.
In the original BISO-CAD study, bisoprolol led to significant lowering of RHR, which was associated with reduced CCCO and hospitalization for unstable angina or revascularization in Asians with CAD. Patients who achieved an RHR of ≥70 bpm had an increased risk of the composite cardiac outcomes compared with those achieving <70 bpm after treatment with bisoprolol (p =0.0328). [Curr Med Res Opin 2018;34:217-225]
“The findings showed bisoprolol to be efficacious, in terms of lowering RHR and causing a significant decrease in the occurrence of the composite cardiac outcome, as well as safe in Asian patients with CAD,” said the researchers.
More than three-quarter (n=681/866, 78.6 percent; mean ae 64.77 years, 69 percent male) of the original cohort with CAD from the phase IV, multinational, single-arm, open-label, real-world BISO-CAD study who were treated with bisoprolol were included in the analysis. The primary endpoint was CCCO, which comprised of nonfatal acute myocardial infarction, cardiovascular death, and hospital admission for unstable angina or revascularization. RHR was significantly lowered at 6, 12, and 18 months from baseline (p<0.0001). [ACC Asia 2018, abstract 1171637]
Achieving an RHR of <65 bpm after treatment with bisoprolol was associated with significantly improved CCCO compared with an RHR of ≥65 bpm (p=0.0429). Similarly, achieving an RHR of <70 bpm was associated with significant improvement in CCCO relative to RHR of ≥75 bpm (p=0.0305).
Compared with an RHR of <69 bpm, achieving an RHR of 69–74 bpm was associated with significantly greater CCCO (p=0.0102) and acute coronary syndrome events (p=0.0149).
Also, patients with RHR of ≥70 bpm had a significantly worse left ventricular end systolic dimension than those with an RHR of <70 bpm (p=0.0003).
Adverse events were reported in 163 (23.9 percent) patients, with 1.3 percent of them being related to the treatment drug.
“Bisoprolol significantly reduced RHR and improved CCCO in Asian CAD patients with comorbid hypertension,” said the researchers. “In real-world practice, beta-blockers showed beneficial effects in [this group of patients].”