Heart failure & cardiomyopathiesRandomised controlled trial
Beta-Blocker (Bisoprolol) vs Calcium-Channel Blocker (Verapamil) in Nonobstructive Hypertrophic Cardiomyopathy
- Randomised controlled trial
- double-blind
- placebo-controlled
- triple-crossover
Authors' conclusion
In nonobstructive HCM, treatment with bisoprolol reduced pVO2, whereas it was unchanged with verapamil.
Study context
- Population
- Nonobstructive hypertrophic cardiomyopathy (HCM) with ≥1 marker of disease severity (NYHA class ≥II, NT-proBNP >300 ng/L, or documented nonsustained VT)crossover
- Participants
- 32 participants
- Comparison
- Bisoprolol vs verapamil vs placebo
- Primary endpoint
- Peak oxygen consumption (pVO2)
- Follow-up
- After 2 weeks on steady-state treatment
Primary result
As reported in the abstract
pVO2
- Bisoprolol vs Verapamil
- adjusted mean difference −1.8 mL/kg/min; P = 0.013
- Bisoprolol vs Placebo
- adjusted mean difference −2.5 mL/kg/min; P = 0.002
- Verapamil vs Placebo
- adjusted mean difference −0.7 mL/kg/min; P = 0.990
Further findings
| Outcome | Estimate | P value |
|---|---|---|
| Peak heart rate — Bisoprolol vs Placebo | difference −37 beats/min | P < 0.001 |
| Peak heart rate — Verapamil vs Placebo | difference −17 beats/min | P < 0.001 |
| Global longitudinal strain — Verapamil vs Placebo · improved | difference −1.1 % | P = 0.001 |
| Global longitudinal strain — Bisoprolol vs Placebo · unchanged | difference −0.6 % | P = 0.263 |
| KCCQ-OSS — Bisoprolol vs Placebo | difference −6.6 points | P = 0.001 |
| KCCQ-OSS — Verapamil vs Placebo | difference −2.3 points | P = 0.668 |
| NT-proBNP — Bisoprolol vs Placebo | difference +165 ng/L | P = 0.006 |
| NT-proBNP — Verapamil vs Placebo | difference −177 ng/L | P < 0.001 |
| Left atrial volume index (LAVI) — Bisoprolol vs Placebo | difference +13.0 mL/m² | P < 0.001 |
| Left atrial volume index (LAVI) — Verapamil vs Placebo | difference +5.2 mL/m² | P = 0.194 |
| TR pressure gradient — Bisoprolol vs Placebo | difference +4.3 mm Hg | P = 0.049 |
| TR pressure gradient — Verapamil vs Placebo | difference +1.1 mm Hg | P = 1.000 |
Oxygen consumption at anaerobic threshold, minute ventilation/CO2 production slope
- Unchanged by bisoprolol or verapamil
NYHA class
- Unchanged by treatments
Original publication
Beta-Blocker (Bisoprolol) vs Calcium-Channel Blocker (Verapamil) in Nonobstructive Hypertrophic Cardiomyopathy. J Am Coll Cardiol. Published 3 March 2026. doi:10.1016/j.jacc.2025.11.028
Summarised from the published abstract; every number is checked against it