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


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 (FEV(1)). The study is registered with ClinicalTrials.gov, number: NCT00702156. Patients were elderly and predominantly male. Cardiovascular comorbidity, smoking history, and pulmonary function were similar in each group (mean FEV(1) 1.37 vs. 1.26 L, P = 0.52). A reduction in FEV(1) occurred after 4 months following treatment with bisoprolol compared with placebo (-70 vs. +120 mL, P = 0.01). Reversibility following inhaled beta(2)-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).


CONCLUSIONS
Initiation of bisoprolol in patients with HF and concomitant moderate or severe COPD resulted in a reduction in FEV(1). However, symptoms and quality of life were not impaired.
Hawkins
Nathaniel M
NM
Aintree Cardiac Centre, University Hospital Aintree, Liverpool L9 7AL, UK. nathawkins@hotmail.com
MacDonald
Michael R
MR
Petrie
Mark C
MC
Chalmers
George W
GW
Carter
Roger
R
Dunn
Francis G
FG
McMurray
John J V
JJ
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D017298:Bisoprolol / Q000627:therapeutic use*; D001784:Blood Gas Analysis; D015897:Comorbidity; D004311:Double-Blind Method; D005260:Female; D005541:Forced Expiratory Volume; D006305:Health Status Indicators; D006333:Heart Failure / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D008168:Lung / Q000502:physiology; D008297:Male; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000188:drug therapy*; D012720:Severity of Illness Index; D012737:Sex Factors; D013147:Spirometry; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014797:Vital Capacity
D000319:Adrenergic beta-Antagonists; D017298:Bisoprolol