Tolerability of initiation and titration with Bisoprolol compared with Carvedilol in systolic heart failure

Abstract

Cardiac failure is one of the most common cardiovascular diseases with high rates of mortality and disability. Beta-blockers have important roles in the treatment of this disease, especially heart failure with reduced EF, Beta-blockers reduce mortality and improve symptoms and left ventricular function. Considering the increasing prevalence of this disease, the present study was conducted to evaluate the tolerable dose and the recommended dose tolerance test by titration of two drugs, Bisoprolol and Carvedilol, in systolic insufficiency. Methods and materials: In this cross-sectional study, the target population were patients with heart failure, who was referred to the heart failure clinic of Tabriz Madani Hospital during 2017 - 2018. Finally, 170 subjects in two groups of 86 and 84 subjects were studied for Bisoprolol and Carvedilol, then followed up for 2 months. In this study, an initial dose was 1.25 mg Bisoprolol and 3.125 mg of Carvedilol in 12 hours, we titrated them over two months. The target dose is 10 mg per day for Bisprolol and 25 mg every 12 hour for carvedilol. Increasing the titration dose was stopped when any complications were observed. Finally, the data were analyzed by SPSS 22 software.

Results: Among the 123 (72.4%) men and 47 (27.3%) women with a mean age of 60.4 ± 17.22 years, we found in the Bisoprolol group, the functional class changed from 0.56 ± 1.47 to 0.54 ± 1.42 and in the Carvedilol group changed from 0.59 ± 1.51 to 0.56 ± 1.46 (P-value = .046). In the studied patients, the mean dose of Bisoprolol was 2.56 ± 5.14 and the mean dose of Carvedilol was 22.42 ± 8.19. Only 20.9% of Bisoprolol group and none of the Carvedilol group reached the target dose. In the Bisoprolol group, systolic blood pressure changed from 131.92± 11.73 mmhg to 122.75 ± 11.80 mmhg and the heart rate changed from 76.89 ± 6.44 to 71.81 ± 6.66 and the ejection fraction changed from 21.43 ± 5.99 to 22.74± 5.27 %. In the Carvedilol group, systolic blood pressure changed from 133.55±12.30 mmhg to 124.72 ± 12.43 mmhg and the heart rate changed from 75.78 ±7.01 to 68.08 ± 6.01 and ejection fraction changed from 20.80±6.41 to 22.27± 5.56% .among all patients, dizziness (21.76%) and weakness (31.17%), bradycardia (25.88%), and hypotension 914.70%) were observed.