BISOMET Write Up Points

BISOMET STUDY
Introduction:
The BISOMET Study is a Multi-Centric randomized
Double blind study to compare the beta blockers
BISOPROLOL and METOPROLOL with regard to the
extend and duration of beta blocker blockade
after 4 weeks of treatment.
Methodology:
87 Hypertensive patients were treated with once
daily with BISOPROLOL 10mg (n=44) or
Metoprolol 100 mg (n=43) in a double blind
randomised study.
Inclusion criteria:
The study included patients of Age between 18
and 70 years, with mild to moderate essential
hypertension and Diastolic BP of >95 to
<=115mmHg took part in the study.
Study:
The patients were randomized into two treatment
groups: one group received capsules containing
10 mg Bisoprolol; the other received capsules of
identical shape and colour containing 100 mg
Metoprolol
Evaluation:
The main aim of the study was to compare the
effects of the beta blockers on systolic blood
pressure (SBP), heart rate (HR) and rate-pressure
product (RPP) following a 4-week treatment

period 24 h and 3h p.a.
Results:
The present study showed that, measured in
terms of the results of an exercise test with
determination of SBP, HR and RPP in patients
with hypertension, the action of 10 mg Bisoprolol
persists throughout the dosage interval of 24 h.
The residual effects 24 h p.a. were 86-93% of the
acute effects 3 h p.a.
Whereas Bisoprolol and Metoprolol showed
comparable 3-hour effects on SBP, HR and RPP
during exercise, the effects observed 24 h p.a.
were significantly less with 100 mg Metoprolol
than with 10 mg Bisoprolol.
For Metoprolol the residual effects 24h p.a. were
53-66% of the acute effects 3hp.a.
In contrast to the findings with 10 mg Bisoprolol,

100 mg Metoprolol does not guarantee a
persistent reduction in exercise blood pressure
and heart rate throughout the entire 24-h dosage
interval.
Authors noted that, Even after once-a-day 200
mg Metoprolol in slow or delayed release
formulations for 2-4 weeks, the differences were
usually relatively small between 0 and 24 h p.a.
and distinct between 24 and 2-4 h p.a. Thus
even in sustained release formulations Metoprolol
does not induce a beta-receptor blockade and
exercise blood pressure control that last
convincingly throughout the 24-h dosage
interval.
Discussion1.Bisoprolol is only beta blocker that is suitable
for single daily administration with the
objective of a beta-receptor blockade that
persists to as great an extent as possible for
24 hours is one with a long plasma
elimination half-life. And the only beta
blocker that is able to guarantee plasma
concentrations at which only the beta,receptors are blocked also at the start of such
a dosage interval of 24 hours is one with a
high beta selectivity
2.Uniformly strong beta-receptor blockade is
particularly desirable and necessary when
coronary heart disease is present. Many
hypertensive patients undoubtedly suffer

additionally from symptomatic or
asymptomatic coronary heart disease. In
these patients the persistent reduction in
rate-pressure product under exercise
conditions is helpful in reducing angina
pectoris attacks because such attacks
invariably occur on reaching the same ratepressure product, regardless of the type of
exercise involved.
3.A beta,-receptor blockade persisting
throughout the dosage interval therefore
probably guarantees more constant direct
and indirect favourable effects on blood
pressure than a beta-receptor blockade that
varies considerably during the dosage
interval. The significantly stronger effect on
resting diastolic blood pressure with
Bisoprolol than with Metoprolol that was
observed in the present study can be
interpreted in this sense.
NoteRate Pressure Product (RPP) is an indicator of
myocardial oxygen demand (MVO2)
RPP=HR* SBP
RPP-Rate Pressure Product=mmHg*Bpm
HR-Heart Rate-Bpm
SBP-Systolic Blood Pressure-mmHg.
Rate pressure product (RPP) is a term used in

cardiology, as well as exercise physiology, to
measure the workloador oxygen demandof
the heart, and reflects hemodynamic stress. It is
measured at rest and during various stages of
exercise. At the conclusion of each stage of an
exercise stress test, we document the heart rate
and blood pressure, which is used to compute the
RPP.

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BISOMET STUDY

product (RPP) following a 4-week treatment

In contrast to the findings with 10 mg Bisoprolol,

hypertensive patients undoubtedly suffer

Rate pressure product (RPP) is a term used in

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