Pharmacotherapeutic comparison of beta blockers (bisoprolol, carvedilol, nebivolol): focus on modern data of evidence-based medicine

September 13, 2022

The active use of beta blockers in the treatment of patients with cardiovascular diseases determines the relevance of choosing the optimal drug. The purpose of this review is to compare the mechanism of action, pharmacological properties, and current evidence-based data on the ability of bisoprolol, carvedilol and nebivolol to influence mortality rates. The analysis of these indicators of two beta1 selective blockers (bisoprolol, nebivolol) and one non-cardioselective beta blocker (carvedilol) testifies to the benefit of the original bisoprolol. Due to the peculiarities of the mechanism of action and pharmacological characteristics, bisoprolol has a high affinity for cardiac beta1 adrenergic receptors, is devoid of the effect of first-pass metabolism through the liver, has high bioavailability (which does not depend on the characteristics and speed of metabolism) and clearance evenly distributed between the liver and kidneys, long half-life; bisoprolol does not affect respiratory resistance, carbohydrate and lipid metabolism, erectile function. All this does not have a significant negative effect on bronchial smooth muscles, ensures the predictable effect of bisoprolol on heart rate, blood pressure and provides round-the-clock anti-ischemic and antihypertensive protection. Bisoprolol can be prescribed once a day, recommended for patients with comorbid chronic obstructive pulmonary disease, diabetes, dyslipi­demia, obesity, and young men. The main argument in favor of bisoprolol is its ability to probably improve the survival of patients with hypertension, angina compared to other beta blockers.


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