Effects of bisoprolol in relation to metoprolol and bufuralol on left ventricular hemodynamics at rest and during exercise in chronic ischemic heart disease.

To assess acute hemodynamic effects of bisoprolol on left ventricular hemodynamics at rest and during exercise, 16 patients with documented chronic ischemic heart disease were studied and compared with patients after administration of metoprolol and bufuralol. Simultaneous right heart catheterization and radionuclide angiocardiography were performed at rest and during exercise before and after drug administration. Bisoprolol was given orally to 16 patients, six receiving 5 mg, and 10 patients receiving 20 mg. Metoprolol was injected intravenously in a dose of 0.15 mg/kg to another 16 patients, and 30 mg bufuralol were given orally to 10 patients. The hemodynamic profiles of all three compounds were similar to that previously described after acute beta-blockade. All three drugs tested and compared showed a marked negative chronotropic effect, while there were slight differences in the negative inotropic and blood pressure lowering effect. Bisoprolol induced only mild negative inotropic changes, which were barely detectable after the 5 mg dose. The negative inotropic changes were more pronounced after metoprolol, and were partly balanced by the vasodilating properties of bufuralol. Thus, bisoprolol showed a significantly reduced rate pressure product with only a relatively mild negative inotropic effect. Based on these observations, even the higher dose of 20 mg bisoprolol seems to be hemodynamically safe for clinical application.