National Consensus 2025 on Role of Bisoprolol Across CV Continuum in Women: Top 10 Takeaways

An Indian expert panel has issued a consensus statement highlighting the role of bisoprolol across the cardiovascular care continuum, with a special focus on women.

Published in the latest issue of JAPI (May 2025), the consensus statement is based on a systematic review of clinical data, peer-reviewed studies, and real-world evidence, aligning with global and regional guidelines. The process involved evaluating bisoprolol’s efficacy and safety in managing hypertension, HF, ischemic heart disease, cardiomyopathies, tachyarrhythmias, and CKD, emphasizing women’s distinct clinical needs and cardiovascular risk profiles. In-depth discussions assessed gender-specific considerations, with the final consensus shaped by the panel’s collective expertise to ensure alignment with established guidelines.

Here are the top 10 key takeaways:

1. Burden of Cardiovascular Disease in Women: CVDs remain a leading cause of mortality among Indian women, driven by hypertension, diabetes, and obesity. The 2024 NFHS-5 reports a 35.5% prevalence of hypertension, rising to 52% in women aged ≥75 years. According to the World Heart Federation, CVDs account for 36.99 million DALYs annually, with 1.54 million deaths among women.

2. Gender-Specific Cardiovascular Risks and Care Gaps in Indian Women: CVDs in Indian women, including acute coronary syndrome, tachyarrhythmias, and cardiomyopathies, present distinct challenges, with higher mortality despite lower prevalence in some conditions. Hormonal influences, pregnancy complications, and metabolic factors increase susceptibility, yet women remain underdiagnosed and undertreated due to cultural, social, and systemic barriers.

3. Bisoprolol’s high cardioselectivity offers many advantages: Bisoprolol’s cardioselectivity offers multiple advantages in CVD patients particularly those with comorbidities such as COPD, diabetes, dyslipidemia, peripheral vascular disease due to less interference in metabolism, respiratory function and peripheral circulation. In addition, it has minimal effect of on sexual function as well. It requires minimal or no dose adjustments due to balanced clearance.

4. Bisoprolol in Hypertension Predictable Pharmacological Profile & 24-hour BP Control: Bisoprolol provides consistent 24-hour BP control in hypertensive patients. Bisoprolol, being a selective β1-blocker, is recommended in hypertension guidelines for both monotherapy and combination therapy. In creative study, Bisoprolol provides superior HR control with similar BP effects in comparison with metoprolol.

5. Bisoprolol- First Beta-blockers to Improve HF Outcomes: It significantly reduces mortality and CV events in HF, especially in women and patients with HFrEF. As the first β-blocker to improve HF outcomes, it remains central to current guidelines. Additionally, its role in significantly reducing Sudden cardiac death (46%) in HFrEF reinforces its importance in optimal HF management. As the use of ARNI has gained momentum in the GDMT of HF, it becomes increasingly important to select the right beta blocker to pair with ARNI. Bisoprolol is particularly well-suited as the preferred BB in combination with ARNI.

6. Bisoprolol Improves outcomes in NSTEMI/STEMI: Early initiation at low doses has been associated with a significant reduction in all-cause mortality, VA, MACEs, and CV events in both STEMI and NSTEMI. Maclean et al. study reported that early administration of bisoprolol (<4 hours) was associated with significantly fewer VA (1 vs. 20, p = 0.034), cardiac deaths (0 vs. 13, p = 0.044), and MACE (1 vs. 27, p = 0.005) compared to the late group. After adjusting for confounders, bisoprolol demonstrated protective effects against VA (OR 0.114, p = 0.038) and MACE (OR 0.064, p = 0.011), with 36.5% of patients being women.

7. Bisoprolol Improves Clinical Outcomes in Chronic Coronary Syndrome: Bisoprolol is the preferred β-blocker for stable CAD worldwide, with strong evidence supporting its benefits across the CAD spectrum. Bisoprolol effectively reduces ischemic episodes and angina frequency in patients with chronic stable angina, including women. Terol et al. reported that bisoprolol, administered once daily, is an effective and well tolerated antianginal treatment, showing significant reduction in angina attack frequency The TIBBS study demonstrated that bisoprolol 10 mg daily reduced transient ischemic episodes by 60.5% (8.1 to 3.2 per 48 hours, p < 0.0001) and ischemia duration by 56.1% (72.6 to 31.9 minutes per 48 hours, p < 0.0001), with a 68% reduction in the morning ischemic peak, highlighting its circadian benefit.

8. Bisoprolol Benefits Rate Control in AF & SVT: Bisoprolol is recommended for rate control in AF and SVT, particularly in women with HF. It is beneficial in lowering HR in patients with AF and thereby it improves symptoms and quality of life. The 2024 ESC and 2023 ACC/AHA/ACCP/HRS guidelines endorse bisoprolol as a first-line β-blocker for AF, with a dose range of 1.25–20 mg (ESC) and 2.5–10 mg (ACC/AHA/ACCP/HRS), considering its 9–12-hour half-life. Bisoprolol effectively lowers the burden of ventricular arrhythmias in patients with PVC.

9. Bisoprolol in CKD – Preferred Beta-blocker Among Nephrologists: Bisoprolol has shown safety and efficacy across the entire spectrum of CKD, including patients not on dialysis. Its minimal dialyzability ensures that BP remains stable during dialysis, reducing CV adverse events compared to other BB. These advantages make bisoprolol the preferred β-blocker among nephrologists. A study involving 9,305 hemodialysis patients reported a 34% reduction in all-cause mortality and a 26% reduction in MACEs with bisoprolol compared to carvedilol, further reinforcing its safety and efficacy across the CKD spectrum.

10. Bisoprolol in various cardiomyopathies: Bisoprolol has demonstrated efficacy across cardiomyopathies, particularly in DCM, where it improves left ventricular function, reduces hospitalizations, and enhances survival. Evidence also supports its role in HCM, aiding symptom control and reducing arrhythmic risk.

Reference: Chopra HK, Sethi KK, Nair T.et al. National Consensus Statement on Role of Bisoprolol across Cardiovascular Continuum: Special Focus on Women. J Assoc Physicians India 2025;73(5):e16–e33.

Abbreviations: CV: cardiovascular HF: heart failure, CKD: chronic kidney disease, CVD: Cardiovascular diseases, NFHS: National Family Health Survey, DALYs: disability-adjusted life years, DCM: dilated cardiomyopathy, HCM: hypertrophic cardiomyopathy, HFpEF: HF with preserved ejection fraction, LVOT: Left Ventricular Outflow Tract, SCD: sudden cardiac death, CIBIS II: Cardiac Insufficiency Bisoprolol Study II, NSTEMI: non-ST-elevation myocardial infarction, VA: ventricular arrhythmias, MACE: major adverse cardiovascular events, BRIGHT: Bisoprolol in Resting Heart Rate Study, SVT: supraventricular tachycardia, AF: atrial fibrillation, TIBBS: Total Ischemic Burden Bisoprolol Study, ESC: European Society of Cardiology, ACC/AHA/ACCP/HRS: American College of Cardiology/American Heart Association/American College of Clinical Pharmacy/Heart Rhythm Society, INDUS: INDia Ukieri Study.