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European Journal of Heart Failure Advance Access originally published online on May 21, 2009
European Journal of Heart Failure 2009 11(7):684-690; doi:10.1093/eurjhf/hfp066
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org.

Bisoprolol in patients with heart failure and moderate to severe chronic obstructive pulmonary disease: a randomized controlled trial

Nathaniel M. Hawkins1,*, Michael R. MacDonald2, Mark C. Petrie2, George W. Chalmers2, Roger Carter2, Francis G. Dunn3 and John J.V. McMurray4

1 Aintree Cardiac Centre, University Hospital Aintree, Longmoor Lane, Liverpool L9 7AL, UK
2 Royal Infirmary, Glasgow, UK
3 Stobhill Hospital, Glasgow, UK
4 Western Infirmary, Glasgow, UK

* Corresponding author. Tel: +44 151 529 2717, Fax: +44 151 529 2724, Email: nathawkins{at}hotmail.com


  Abstract

Aims: Heart failure (HF) and chronic obstructive pulmonary disease (COPD) frequently coexist. No study has prospectively examined the effects of beta-blockade in those with both conditions.

Methods and results: We randomized 27 patients with HF and coexistent moderate or severe COPD to receive bisoprolol or placebo, titrated to maximum tolerated dose over 4 months. The primary outcome was forced expiratory volume in 1 s (FEV1). The study is registered with ClinicalTrials.gov, number: NCT00702156 [ClinicalTrials.gov] . Patients were elderly and predominantly male. Cardiovascular comorbidity, smoking history, and pulmonary function were similar in each group (mean FEV1 1.37 vs. 1.26 L, P = 0.52). A reduction in FEV1 occurred after 4 months following treatment with bisoprolol compared with placebo (–70 vs. +120 mL, P = 0.01). Reversibility following inhaled β2-agonist and static lung volumes were not impaired by bisoprolol. All measures of health status exhibited a consistent non-significant improvement, including the Short Form 36 physical and mental component scores (2.6 vs. 0.5 and 0.8 vs. –0.3, respectively), Minnesota Living with Heart Failure Questionnaire (–2.5 vs. 3.5) and Chronic Respiratory Questionnaire (0.07 vs. –0.24). The mean number of COPD exacerbations was similar in the bisoprolol and placebo groups (0.50 and 0.31, respectively, P = 0.44).

Conclusion: Initiation of bisoprolol in patients with HF and concomitant moderate or severe COPD resulted in a reduction in FEV1. However, symptoms and quality of life were not impaired.

Key Words: Heart failure • Chronic obstructive pulmonary disease • Beta-blockers

Received March 17, 2009; Revised March 19, 2009; Accepted March 27, 2009


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