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Which betablocker to take? Heart insufficiency / cardiomyopathy

[email protected]

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Hello guys,
in reference to my other thread:
(short summary: Heart insufficiency stage III since beginning of May, EF around 20%, they assume due to "non-compaction cardiomyopathy")

i need advise which beta-blocker i should take since i have different opinions from docs:
1.) Nebivolol starting dosage 2,5mg
2.) Carvedilol 2x 6,25mg starting dosage.

All would be tiatred up to the final dosage (10mg for Nebivolol, 2x 25mg for cardevilol)
thanks guys!
regards,
Manuel
 

Huehnerbruestchen

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Hey mate.

I personally would stick to Nebivolol. 10mg seems quite a lot, I've tried 7,5mg in the past but just for a couple days and man, i can tell my heart rate was fucking low, it scared the shit out of me. When
sitting it went as low as 35-40 beats per minute, I could feel and hear how slow and relaxed the heart beat was in my ears, really scary. I didnt feel good with such a low heart beat.
 

[email protected]

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yeah this is the maximum dosage, maybe less will do it.
Main issue right now is low BP, it is around 105/60 and i still hve to increase dosage of entresto and beta blocker and diuretic :-|
 

maldorf

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I was on 80 mg/ day Carvedilol. It was a single timed release cap I took at bedtime.

It was dropping my BP too low so we switched to Bisoprolol. I take 10 mg/day now of Bisoprolol. It must be really strong. I'm taking a beta blocker just to keep my heart rate down,, not for BP reduction.

The Bisoprolol is more beta 1 specific, so doesn't affect the smooth muscle in the vasculature. Relaxing those muscles will decrease BP too much for Me.


Not sure what your needs are. Is your BP already nearly too low? If it is, ask your doctor about Bisoprolol. Not sure if Nebivolol is beta 1 specific.
 

warlock

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I'd go with nebivolol. This med has proven to have lots of extra benefits.
 

fozzyred

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I say Nebivolol as well. That's what I take, along with Telmisartan.
 

maldorf

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Nebivolol is beta 1 specific up to 10mg dose. Which is what i take.
Looks like the two are very similar. This study was done on lowering BP, so not really done on lowering heart rate. Since Nebrivolol is beta 1 selective like bisoprolol, I'd assume similar results there as well.

For whatever reason, my cardiologist selected Bisoprolol for me. We were looking for something that wouldn't lower my BP so much but keep my heart rate down.

 

maldorf

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A study that compares all 3 drugs. Looks like Bisoprolol does in fact lower heart rate more than the others. Thats what I needed. Manuel might need something different?

"
Results: Heart rate at exercise was decreased at 3 h following intake of the first single dose of each drug by bisoprolol (-24%), carvedilol (-17%) and nebivolol (-15%), and at 24 h following intake of the respective last dose of each drug following 1 week of chronic administration by bisoprolol (-14%), carvedilol (12 h; -15%) and nebivolol (-13%) (p < 0.05 in all cases). Thus, trough-to-peak-ratios at long-term were as follows: Bisoprolol, 58%; carvedilol (12 h), 85%; nebivolol, 91%. Nocturnal melatonin release was decreased by bisoprolol (-44%, p < 0.05) whereas nebivolol and carvedilol had no effect. QOL with carvedilol was slightly but significantly lower than with the other drugs, whereas bisoprolol and nebivolol did not alter QOL.

Conclusions: These data show that peak beta-blocking effects of bisoprolol appear stronger than those of nebivolol and carvedilol. On the other hand, nebivolol exerts the highest trough-to-peak-ratio. However, beta-blocking effects of all the three drugs are similar at trough. Only bisoprolol but neither nebivolol nor carvedilol decreased nocturnal melatonin release, a feature which might cause sleep disturbances. Finally, only carvedilol slightly decreased QOL, whereas nebivolol and bisoprolol did not affect QOL. We conclude that different beta-blockers may exert clinically relevant different effects."


Carvedilol was the only one that patients rated as lowering their quality of life. Bisoprolol was noted as lowering melatonin release at night. Nothing noted on Nebivolol. I never felt like Bisoprolol affected my sleep negatively.
 

SouthernMuscle

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Looks like the two are very similar. This study was done on lowering BP, so not really done on lowering heart rate. Since Nebrivolol is beta 1 selective like bisoprolol, I'd assume similar results there as well.

For whatever reason, my cardiologist selected Bisoprolol for me. We were looking for something that wouldn't lower my BP so much but keep my heart rate down.
Nebivolol is also a vasodilator so would likely cause a lower bp than bisoprolol
 

maldorf

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Nebivolol is also a vasodilator so would likely cause a lower bp than bisoprolol
That first study I posted showed it did a little bit more , but not significantly. Seems both are beta 1 selective.
 

[email protected]

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BP is absolutely no issue for me, on the contrary, i am currently sitting @ 105-108/59-63 and i still have to increase the dosage of my beta blocker, my entresto and the diuretics. So i have to make sure i dont drop too low to stay functional since even right now i sometimes get moments where my low BP annoys me..
Heart rate is usually in the high 60s. my 24 hour ecg says lowest was 48 measured somewhere in the night, highest of that particular day 122 during some cycling. mean HR is high 60`s - medium 70's
In my case, i am most interested in increasing my Ejection Fraction / remodeling my left ventrical.
From what ive read, nebivolol has some studies that back that up.
 

Huehnerbruestchen

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Especially for activities like cycling and so and I would highly prefer Nebivolol over anything else.
And yes, Nebivolol has plenty of studies showing improvements in left ventrical function and increasing EF as well.
Seems the best option to me.
 

[email protected]

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Especially for activities like cycling and so and I would highly prefer Nebivolol over anything else.
And yes, Nebivolol has plenty of studies showing improvements in left ventrical function and increasing EF as well.
Seems the best option to me.
i think the same after researching quite a bit yesterday and this morning.
Now i just have to get the dosage up without dropping to the floor due to hypotension, haha
 

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