From the Research
Bisoprolol is the preferred beta blocker for treating amyloidosis, starting at a low dose of 1.25-2.5mg daily, with careful titration based on blood pressure and heart rate response, as it has been shown to be effective in reducing mortality in patients with cardiac amyloidosis, particularly those with a left ventricular ejection fraction (LVEF) ≤40% 1.
Key Considerations
- Beta blockers, such as bisoprolol, are used to manage symptoms and improve heart function in cardiac amyloidosis, with the goal of reducing heart rate, improving diastolic filling time, and decreasing oxygen demand.
- The target dose of beta blockers in cardiac amyloidosis should be lower than standard heart failure regimens, aiming for heart rates around 60-70 beats per minute while maintaining adequate blood pressure.
- Patients with amyloidosis may be sensitive to the effects of beta blockers, particularly hypotension, and require regular monitoring of vital signs, symptoms, and cardiac function.
- Beta blockers should be part of a comprehensive treatment approach that addresses the underlying amyloid disease process, which may include specific therapies depending on the amyloid type (AL, ATTR, or other variants).
Evidence-Based Recommendations
- A study published in the European Heart Journal in 2023 found that low-dose beta blockers, such as bisoprolol, were associated with reduced risk of mortality in patients with cardiac amyloidosis and a LVEF ≤40% 1.
- Another study published in the European Journal of Internal Medicine in 2020 found that beta blockers, including bisoprolol, were well-tolerated in patients with cardiac amyloidosis, with no increased risk of adverse events 2.
- A nationwide survey published in ESC Heart Failure in 2021 found that beta blockers, including bisoprolol, were commonly used in cardiac amyloidosis, with a prescription rate of 55.4% 3.