Beta-Blocker (Bisoprolol) vs Calcium-Channel Blocker (Verapamil) in Nonobstructive Hypertrophic Cardiomyopathy: A
Louise Bjerregaard1, Anne M Dybro2, Lotte Saaby3
1Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
Journal of the American College of Cardiology
|March 4, 2026
Summary
In nonobstructive hypertrophic cardiomyopathy (HCM), bisoprolol reduced peak oxygen consumption (pVO2), while verapamil did not. Verapamil improved myocardial function and reduced biomarkers, unlike bisoprolol.
Area of Science:
- Cardiology
- Pharmacology
- Internal Medicine
Background:
- Randomized evidence for beta-blocker and calcium antagonist use in nonobstructive hypertrophic cardiomyopathy (HCM) is lacking.
- Nonobstructive HCM patients with disease severity markers were included in this study.
Purpose of the Study:
- To analyze the effects of bisoprolol and verapamil in nonobstructive HCM.
- To compare bisoprolol, verapamil, and placebo in a randomized, double-blinded, triple-crossover trial.
Main Methods:
- Thirty-two patients with nonobstructive HCM received bisoprolol, verapamil, or placebo for 2 weeks each.
- Primary outcome was peak oxygen consumption (pVO2); secondary outcomes included exercise response, symptoms, biomarkers, and structural changes.
Main Results:
- Bisoprolol reduced pVO2 (-2.5 mL/kg/min vs placebo; P=0.002), while verapamil did not (-0.7 mL/kg/min vs placebo; P=0.990).
- Verapamil improved global longitudinal strain and reduced NT-proBNP, whereas bisoprolol worsened symptoms (KCCQ-OSS), increased NT-proBNP, and enlarged left atrial volume index.
- Both drugs reduced peak heart rate, but neither altered anaerobic threshold or ventilation/CO2 production slope.
Conclusions:
- Bisoprolol negatively impacted pVO2 and cardiac structure/function in nonobstructive HCM.
- Verapamil demonstrated a neutral effect on pVO2 but improved myocardial function and biomarkers.
- Findings offer insights into drug mechanisms for managing nonobstructive HCM.
Keywords:
beta-blockerbiomarkercalcium-antagonistfunctional capacityhypertrophic cardiomyopathymyocardial functionsymptomsMore Related Videos
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