Bisoprolol proves safer than carvedilol for patients on dial
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For patients receiving hemodialysis in Taiwan, bisoprolol demonstrated superior safety compared with carvedilol, according to a study of the two betablockers.

Despite widespread use, there is no trial evidence to inform β-blocker’s (BB) relative safety and efficacy among patients undergoing hemodialysis (HD). Researchers herein compare health outcomes associated with carvedilol or bisoprolol use, the most commonly prescribed BBs in these patients.

Researchers created a cohort study of 9305 HD patients who initiated bisoprolol and 11171 HD patients who initiated carvedilol treatment between 2004 and 2011. They compared the risk of all-cause mortality and major adverse cardiovascular events (MACEs) between carvedilol and bisoprolol users during a 2-year follow-up.

-- Bisoprolol initiators were younger, had shorter dialysis vintage, were women, had common comorbidities of hypertension and hyperlipidemia and were receiving statins and antiplatelets, but they had less heart failure and digoxin prescriptions than carvedilol initiators.

-- During our observations, 1555 deaths and 5167 MACEs were recorded.

-- In the multivariable-adjusted Cox model, bisoprolol initiation was associated with a lower all-cause mortality compared with carvedilol initiation.

-- After accounting for the competing risk of death, bisoprolol use (versus carvedilol) was associated with a lower risk of MACEs and attributed to a lower risk of heart failure and ischemic stroke, but not to differences in the risk of acute myocardial infarction.

-- Results were confirmed in propensity score matching analyses, stratified analyses and analyses that considered prescribed dosages or censored patients discontinuing or switching BBs.

Conclusively, relative to carvedilol, bisoprolol initiation by HD patients was associated with a lower 2-year risk of death and MACEs, mainly attributed to lower heart failure and ischemic stroke risk.