Acute effects of low-dose bisoprolol on lung function and blood pressure in COPD patients

Recent observational data suggest that cardioselective β-blockers like bisoprolol are safe and beneficial for patients with COPD. However, the acute effects of bisoprolol on lung and cardiovascular function in these patients is unclear, a gap that this study aimed to address.

This was a subanalysis of pre-randomisation screening visit data from the ongoing Preventing Adverse Cardiac Events (PACE) in COPD randomised controlled trial. If all other eligibility criteria were met, participants were orally administered an unblinded 1.25 mg tablet of bisoprolol. Post-bronchodilator spirometry, heart rate and blood pressure were monitored at 0, 30 (cardiovascular parameters only), 60 and 120 min. For this subanalysis, respiratory intolerance was defined as a decrease in forced expiratory volume in 1 s (FEV₁) (L) ≥200 mL and ≥12% from the 0-min FEV₁ (L) value; and cardiovascular intolerance was defined as systolic blood pressure (SBP) falling below 100 mmHg at 1 or 2 h.

Of 359 consented participants, 292 conducted the test-dose procedure. 13 (4.5%) were respiratory intolerant and six (2.1%) were cardiovascular intolerant at 1 or 2 h. No participant was intolerant for both. There was no significant difference in FEV₁ (L) or SBP at baseline At 120 min the intolerant group's mean FEV₁ had significantly decreased to 1.05 L (95% CI 0.86-1.25 L; p<0.0001); the tolerant group experienced no change (1.10, 1.05-1.14 L; p=0.33).

The administration of 1.25 mg bisoprolol was acutely well tolerated in >95% of COPD patients.