bisoprolol vs metoprolol dose conversion

Some beta-blockers, e.g. are generally prescribed for heart failure in New Zealand; there is no strong evidence of effectiveness for one Bisoprolol works on heart-specific receptors to lower blood pressure and slow heart rate; however, cardioselectivity may be lost if dosages are greater than 20mg/day. A review of the different properties of beta-blockers, their role Only monitoring data with valid data >=80% was used for analysis. Tolerance to treatment By working on the beta-1 receptor of the cardiac muscle cells, it yields both a chronotropic and inotropic effect. The primary end points were the mean dynamic HR reduction and the mean dynamic diastolic BP (DBP) control in the last 4 h of the treatment period. . The difference between the mean ambulatory daytime blood pressure observed at Week 12 and baseline was calculated to find out the change of mean ambulatory daytime blood pressure at the end of the treatment. 2.5 mg. 2.5-10mg. Beta Blocker Conversion Table. 2017. carvediolol or metoprolol, are metabolised Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology]. dose over several months, e.g. September 26, 2013. Nadolol 80mg daily. Metoprolol succinate may cost between $14 and $44 for a one-month supply, while metoprolol tartrate may cost anywhere from $4 to $18 . 4 hours. This is because carvedilol has vasodilating properties that help relax blood vessels and lower blood pressure. Available from: OGara PT, Kushner FG, Ascheim DD, et al. Yancy C, Jessup M, Bozkurt B, et al. arrhythmias and the prevention of sudden cardiac Death. Beta blockers work by blocking the effects of the hormone epinephrine, also called adrenaline. Also, your doctor may prescribe a beta blocker as one of several medications to lower your blood pressure. Zealand before alternative options, e.g. Spironolactone, sold under the brand name Aldactone among others, is a medication that is primarily used to treat fluid build-up due to heart failure, liver scarring, or kidney disease. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Finally mean heart rate was recorded. Metoprolol tartarate was discontinued 12 h before the initiation of bisoprolol therapy. The first dynamic blood pressure monitoring was used as baseline. Metoprolol and hydrochlorothiazide (50 mg/25 mg, 100 mg/25 mg, 100 mg/50 mg) . Bisoprolol 5 mg PO DAILY. CrCl <40, cirrhosis, heart failure (10mg . Fish. Information on the management of atrial fibrillation is available from: bpac.org.nz/2017/af.aspx. Waldo AL, Camm AJ, deRuyter H, et al. No studies have directly compared the blood pressure lowering effects of carvedilol and metoprolol. enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), diuretics or calcium channel blockers are associated N Z Med J 2012;125:12247. Eur J Prev Cardiol 2012;19:33041. and New Zealand. Each ABPM lasted for at least 24 hours. Bockstall K, Bangalore S. How long should we continue beta-blockers after MI? Possible alternatives to metoprolol succinate for treating heart failure include bisoprolol and carvedilol. A total of 454 drugs are known to interact with bisoprolol: A total of 496 drugs are known to interact with metoprolol: ** The Controlled Substances Act (CSA) schedule information displayed applies to substances regulated under federal law. 2.3k views Reviewed >2 years ago. Metoprolol is a beta-blocker and diltiazem is a calcium channel blocker. A 200 mg modified-release form of metoprolol tartrate, taken once daily, is available fully subsidised in New Zealand. Patients receiving betablockers other than . Metoprolol tartrate, also known by the brand name Lopressor, is an immediate-release oral tablet that comes in strengths of 25 mg, 37.5 mg, 50 mg, 75 mg, and 100 mg. Metoprolol succinate, also known by the brand name Toprol XL, is an extended-release oral tablet that comes in strengths of 25 mg, 50 mg, 100 mg, and 200 mg. RELATED: Metoprolol vs . Beta-blockers: their properties and use in hypertension. All beta-blockers are considered to be equally effective (as fourth-line treatment) Post-myocardial infarction. The difference between the two drugs is not essential, but there is a difference. than non-selective beta-blockers.21 However, peripheral vasoconstriction may still occur due to the reduction A comparison of a controlled release (CR/ZOK) formulation of metoprolol, once daily, with conventional metoprolol tablets, twice daily, in mild to moderate hypertension. If re-vascularisation did not occur the beta-blocker is likely to be 190 mg of metoprolol succinate equivalent to 25, 50, 100 and 200 mg of metoprolol tartrate, USP, respectively. the estimated daily infant dose of metoprolol received from breastmilk ranges from 0.05 mg to less than . after myocardial infarction.11 Alternatives exercise capacity. Drug and Therapeutics Newsletter 2004;11(3);5. Bisoprolol & Metoprolol are selective 1 adrenergic blockers used in treatment of several diseases, including hypertension (HTN). When a beta-blocker is initiated, a slow upwards titration of dose is recommended to minimise adverse effects. doi: 10.1002/j.1552-4604.1990.tb03498.x. the blood brain barrier.21 If a patient reports adverse effects related to the central nervous system that There are people who take 400mg a day. "Bisoprolol" should take it less often than the first. bisoprolol. For other conditions, Noncompliance was reported in 3 (3.53%) and 6 (7.32%) patients in the bisoprolol and metoprolol CR/ZOK groups, respectively. Appendices > 03. for the treatment of heart failure, beta-blockers now have a limited role in the treatment of hypertension and are routinely Each ABPM lasted for at least 24 hours. Ramipril. In the last 4 h of the treatment period, patients receiving bisoprolol demonstrated a significantly greater reduction in the mean dynamic HR compared with patients receiving metoprolol CR/ZOK (least squares means (LSmeans) of difference: -3.79 b.p.m. Winner = both. 77% of reviewers reported a positive effect, while 12% reported a negative . stimulation of the pulmonary beta2-adrenoceptors thus causing bronchoconstriction and reducing the effectiveness Read More. Find out how bisoprolol treats high blood pressure (hypertension) and heart failure, and how to take it. Garlic. Clipboard, Search History, and several other advanced features are temporarily unavailable. and then up-titrated at 12 week intervals (Table I). Finally mean heart rate was recorded. Beta-blockers or calcium channel blockers are recommended as the first-line anti-anginal medicines.7 There 95 ratings on Drugs.com. The adverse effect profile varies between beta-blockers according to their properties (Table 1). bisoprolol and metoprolol both increase anti-hypertensive channel blocking. As mentioned, most patients can be initially switched to 6.25 mg or 12.5 mg b.i.d. Online ahead of print. This website was made to assist in clinical knowledge recall and to supplement and support clinician judgement. Prescriber 2010;5. However, the beta-blocking effects of these drugs have never been compared directly. Long-term beta blockers for stable angina: systematic review and meta-analysis. Adult. MeSH Before For this non-overlapping or abrupt switching, the current blocker should be discontinued approximately 12 hours before the first dose of carvedilol. Faculty Editor: Elisabeth Askin, MD, CrCl <40, cirrhosis, heart failure (10mg total daily), Weight <85kg, heart failure (50mg total daily), Contraindicated in severe liver impairment. preferred for patients with co-existing chronic obstructive pulmonary disorder (COPD) because they cause less bronchoconstriction, 72% were prescribed metoprolol succinate; the seventh most prescribed medicine in New Zealand, 4% were prescribed carvedilol or propranolol, Reperfusion techniques and the routine use of statins and anti-platelet medicines post-myocardial infarction mean In 2016, 325 000 people received a beta-blocker from a community pharmacy in New Zealand:1, This pattern of prescribing is different to other countries, such as Australia where less than 5% of patients are All Approximately Equivalent Doses Reasonable for Substitution in Most Cases. Sotalol is probably the best antiarrhythmic among the beta-blockers. As seen in figure 1, the most commonly prescribed beta-blocker medications are metoprolol succinate and metoprolol tartrate. This site complies with the HONcode standard for trust- worthy health information: verify here. prescribed to patients with heart failure. Celiprolol Only monitoring data with valid data >=80% was used for analysis. Daytime in this study was defined as 06:00 am to 10:00 pm. Recommended starting doses depend on the clinical scenario. 1990 Feb;30(S2):S66-71. differences, such as beta-adrenergic selectivity, lipid solubility and dual receptor activity, which make each beta-blocker official website and that any information you provide is encrypted ACE inhibitors interfere with the conversion of . Brain Res 2006;1112:11425. over another.12 In Available from: Douglas Pharmaceuticals Ltd. Data sheet: BOSVATE. This indicates that on average, the doctors switched carvedilol to a higher-than-recommended dose of bisoprolol. reduce resting heart rate less than others (due to ISA) tend not to be used for angina, e.g. There are many beta-blockers available, but some of the more common ones include: Starting: 3.125 mg twice a day for 2 weeks. The efficacy of low dose metoprolol CR/ZOK in mild hypertension and in elderly patients with mild to moderate hypertension. 1.25-2.5mg. Secondary end points included ambulatory monitoring of the BP and HR, safety and compliance. Metoprolol, sold under the brand name Lopressor, among others, is a selective 1 receptor blocker medication. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. HHS Vulnerability Disclosure, Help To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. Shalansky K, Sunderji R, et al. target/85 mg q.d. after recent and remote myocardial infarction. Approximate Dose Equivalence: Major Elimination Route: Drug: Beta-1 Selective: ISA: Approximate . for rhythm control include flecainide in younger patients or amiodarone in older patients. The first dynamic daytime blood pressure monitoring was used as baseline. : Dosages of 1.25 to 5 mg every 6-12 hours have been used in short-term management of patients unable to take oral tabs. Cardiovasc Ther 2013;31:7683. 50% of reviewers reported a positive effect, while 23% reported a negative effect. No new safety concerns were found. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. -, Hypertens Res. block and stimulate beta-adrenoceptors causing less bradycardia and peripheral vasoconstriction.5 This may Guidelines recommend beta blocker therapy for three years, but that may not be necessary. Heart rate response rate was calculated by using the number of subjects with heart rate response divided by total number of subjects and multiplied by 100. Bystolic (Nebivolol) is a good blood pressure-lowering medicine for people with heart conditions, and has fewer side effects than other beta blockers, but it's expensive. The difference between the last 24 hours heart rate at Week 12 and of the baseline heart rate was calculated. Nighttime was defined as 10:00 pm to 06:00 am. Some beta blockers mainly affect the heart, while others affect both the heart and blood vessels. If someone adds a reply to one of your comments (or replies) you will recieve an email notifying you of this. 2019 May;21(5):648-657. doi: 10.1111/jch.13543. All beta-blockers produce competitive antagonism of beta-adrenoceptors in the autonomic nervous system.3 This Prescribed for Supraventricular The first nighttime blood pressure monitoring was used as baseline. practice, carvedilol is usually first-line if heart failure is associated with atrial fibrillation, followed For secondary prevention of myocardial infarction, the evidence is best for timolol. In addition, the appropriate dosage . If necessary, a third (and final) 500 mcg/kg loading dose may be administered, prior to increasing to an infusion rate of 150 mcg/minute. has declined since the SWORD (survival with oral d-sotalol) study in the 1990s was discontinued when A cardioselective beta-blocker such as bisoprolol or metoprolol succinate will provide the maximum effect with the minimum amount of adverse effects. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. 1994 Dec;8(6):837-43 Dosage Form(s) Available: Oral tablet; N/A. View this study on Beta.ClinicalTrials.gov, U.S. Department of Health and Human Services, The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Two measurements were made at least 1 to 2 minutes apart. Bisoprolol or metoprolol; consider withdrawal after 6-12 months if re-vascularised and no other indications. Am J Hypertens 2005;18:169S176S. Among these patients, the risk of mortality was not significantly different between carvedilol and metoprolol users (aHR, 0.97 [95% CI, 0.72-1.30]) . Therapeutic Properties of Highly Selective -blockers With or Without Additional Vasodilator Properties: Focus on Bisoprolol and Nebivolol in Patients With Cardiovascular Disease. CSU Metoprolol succinate is available as an extended-release tablet, which means that people only have to take one tablet a day. When comparing it is important to take into account the price: "Metoprolol" is cheaper several times. atenolol, celiprolol or nadolol. Catheter Cardiovasc Interv 2013;82:E1-27. Johns Hopkins Guides. Drugs. Beta-blockers that G Ital Cardiol 2016;17:10870. Bisoprolol 1.25 mg PO daily 10 mg PO daily . Bisoprolol: 1.25 mg qd: 2.5 mg qd: Nebivolol: 1.25 mg qd: 2.5 mg qd: Metoprolol succinate: 25 mg qd: 50 mg qd: 1 more row. Third, we estimated a risk score for . specify which beta-blocker to prescribe.15, 16. Two measurements were made at least 1 to 2 minutes apart. I.V. If you have angina or AF, for example, other drugs that slow the heart rate, such as diltiazem or verapamil, may be substituted. and adverse effects.22, There is evidence that beta-blockers are under-prescribed to patients with COPD, yet they provide significant benefit Bisoprolol is one of the beta blockers which can be used in patients with stable, chronic, moderate to severe heart failure. Daytime in this study was defined as time between 06:00 am to 10:00 pm. There may be variations in CSA schedules between individual states. 2014 Jun;37(6):533-7 Acebutolol 100 mg PO BID. The primary end points were the mean dynamic HR reduction and the mean dynamic diastolic BP (DBP) control in the last 4 h of the treatment period. bisoprolol or metoprolol, are less likely to cause adverse effects, e.g. Primary outcome measure was . The first dynamic blood pressure monitoring was used as baseline. bisoprolol and metoprolol, the dose to every second day for another month, before stopping treatment completely at the time when the patients next preference for frequency of dosing and their likely adherence to treatment. 2013 ACCF/AHA Guideline for the Management of Heart Failure. The first dynamic blood pressure monitoring was used as baseline. Sotalol should be initiated and doses increased in a hospital with facilities for cardiac rhythm monitoring and assessment. angina, a beta-blocker can usually be started at a standard dose. of which varies within each class. Initially prescribe 5 mg daily. -. Both medications significantly reduce the risk of another heart attack from occurring, and there are no obvious differences between the 2 on this front. Tenormin (atenolol) is good for controlling chest pain and treating a heart attack. Priori SG, Blomstrm-Lundqvist C, Mazzanti A, et al. Treatment with beta-blockers--the value of an even plasma concentration over 24 h. The Combination of Beta-Blockers and ACE Inhibitors Across the Spectrum of Cardiovascular Diseases. 2 thanks. Avoid or Use Alternate Drug. unique. Pulses. Thank. Celiprolol and pindolol have intrinsic sympathomimetic activity (ISA) and therefore simultaneously Effect of d-sotalol on mortality in patients with left ventricular dysfunction adverse effects do not resolve, drop back to the previous dose and assess symptom control. have other cardiovascular co-morbidities, such as atrial fibrillation or hypertension.12, Information on the management of heart failure is available from: After 4 minutes of the 150 mcg/kg/minute infusion, the infusion rate may be increased to a maximum rate of 200 mcg/kg/minute (without a bolus dose). in weight of the two salts, but they are therapeutically equivalent, e.g. Metoprolol ER/XL 100mg daily. Nighttime in this study was defined as 10:00 pm to 06:00 am. Unable to load your collection due to an error, Unable to load your delegates due to an error. Each ABPM lasted for at least 24 hours. While both drugs are used to treat heart-related issues, their applications are very different. 2010 Sep;23(9):1023-30 causing vasodilation without affecting cardiac output.3 It has been suggested that this may be preferable in from: National Institute for Health and Care Excellence (NICE). preferred in patients with respiratory disease. Drugs R D. 2014 Dec;14(4):325-32. doi: 10.1007/s40268-014-0073-5. Atenolol 50mg daily. The ABPM determined blood pressure 3 times hourly in the daytime and once hourly in the nighttime. Metoprolol 1,2 bronchospasm IV 2.5-5 mg bolus over 2 min, up to 3 doses N/A hypotension, heart block, bradycardia, , HF succinate ER 25 See black box warnings for this drug Oral 25-100 mg twice daily. The site is secure. Each ABPM lasted for at least 24 hours. Brand Names: N/A. Bisoprolol is processed by both the liver and kidneys therefore does not require dose adjustments for patients with There are three main sub-types of beta-adrenoceptors:3. Finally mean heart rate was recorded. Only monitoring data with valid data >=80% was used for analysis. We have now added the ability to add replies to a comment. CSA Schedule ** View glossary of terms of further cardiac disease. Bryant: -, Cardiovasc Drugs Ther. Kapspargo Sprinkle, Lopressor, Metoprolol Succinate ER, Metoprolol Tartrate, Toprol-XL: Half Life The half-life of a drug is the time taken for the plasma concentration of a drug to reduce to half its original value. government site. If beta-blockers, but there is evidence of benefit for a number of other beta-blockers and international guidelines do not Furthermore, in the last 4 h of the treatment period, bisoprolol demonstrated non-inferiority vs. metoprolol CR/ZOK in lowering the mean dynamic DBP (LSmeans of difference: -1.00; 97.5% CI: -4.79, 2.78; P=0.5495). Pulse rate was measured by palpation on radial artery for 1 minute. similar to 25 mg of metoprolol, which again is about the double strength of propranolol. It is freely This can be increased to a maximum of 360 mg/day in divided doses. No significant clinical decisions should be made based on these images from this website without first consulting with a board-certified attending physician. Occasionally it may The NZF interactions checker provides details on medicine interactions, including their clinical significance, Refer to the New Zealand Formulary for individual beta-blocker dosing regimens: www.nzf.org.nz. The difference between the mean ambulatory nighttime blood pressure observed at Week 12 and baseline was calculated to find out the change of mean ambulatory nighttime blood pressure at the end of the treatment. Subjects received 10 mg bisoprolol, 50 mg carvedilol, 10 mg nebivolol and . The initial dosage of metoprolol succinate ranges from 25-100 mg per day. It is used to treat high blood pressure, chest pain due to poor blood flow to the heart, and a number of conditions involving an abnormally fast heart rate. Save my name, email, and website in this browser for the next time I comment. 2017. I was taking it twice a day to get the full effect for 24 hours (Metoprolol takes about . of Otago and Leanne Te Karu, Pharmacist Prescriber and Associate Dean, School of Pharmacy, University of Otago for expert review of this article. e.g. chest pain, even in those with no history of coronary heart disease. metoprolol 50mg BID. © Copyright BPAC NZ Limited (bpacnz) 2023. achieved) in an immediate-release formulation. Erdmann E. Safety and tolerability of beta-blockers: prejudices and reality. Sotalol. The average final dose in that trial was 159 mg a day and 64% of patients tolerated the target dose of 200 mg a day. Clinic resting Heart Rate >=70 beats per minute (bpm), Patients who have signed informed consent. Metoprolol and Bisoprolol. diltiazem. Up to 5 mg, dose to be given at a rate of 1-2 mg/minute, then up to 5 mg after 5 minutes if required, total dose of 10-15 mg. Note: To achieve more rapid response, following the initial loading dose and 50 mcg/kg/minute infusion, rebolus with a second 500 mcg/kg loading dose over 1 minute, and increase the maintenance infusion to 100 mcg/kg/minute for 4 minutes. If the patients blood pressure is on target, The top 9 with the exception of Bystolic are all generic and therefore relatively inexpensive. Cardioselective beta-blockers, e.g. In people who have diabetes, beta blockers may block signs of low blood sugar, such as rapid heartbeat. and pindolol tend not to be used, Cardioselective beta-blockers, e.g. Available for Android and iOS devices. Esmolol. Survival With Oral d-Sotalol. GrepMed and the images sourced through this website are NOT a substitute for clinical judgement. Propranolol and atenolol have been studied most intensely in hypertension. The crossover was performed within 1 day during monitoring of blood pressure and heart rate in the outpatient clinic. Beta-blockers are classified according to their adrenoceptor binding affinities (Table 1), the degree The ABPM determined blood pressure 3 times hourly in the daytime and once hourly in the nighttime. treatment was modified by reducing the first doses of metoprolol to 50 mg of metoprolol, equivalent to 25 mg of carvedilol. in cardiac output.21 If patients report cold extremities when taking a beta-blocker, a dihydropyridine calcium These medications work by preventing the heart rate from going too high. 19 hours. Timolol 5mg BID. They also are sometimes used to treat conditions related to your brain and nervous system. Your doctor will choose which beta blocker is best for you based on your health conditions. metoprolol SR 100mg daily. All rights reserved. Cardiovasc Drugs Ther. Newest Vasodilatory Beta-Blocker: Nebivolol. The indications for beta-blockers have shifted over the years. *Disclaimer: These are not typical starting doses. Federal government websites often end in .gov or .mil. . swelling and fluid retention, along with weight gain. Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. Bananas. Two measurements were made at least 1 to 2 minutes apart. cannot be managed with a dose reduction, consideration may be given to switching treatment to a water-soluble beta-blocker, View more, Metoprolol is a selective beta-blocker at dosages usually prescribed to lower blood pressure or relieve the symptoms of angina. of randomized trials. in the liver and may be better tolerated by patients with reduced renal function.3. such as sleep disturbances, Polypharmacy: bisoprolol is less likely to interact with other medicines, Renal dysfunction: consider dose adjustments for water-soluble beta-blockers, e.g. Available Available from: National Institute for Health and Care Excellence (NICE). Metoprolol. bisoprolol, were subsidised. The difference between the last 4 hours heart rate after 12-week treatment and of the baseline heart rate was calculated to measure the change in mean heart rate at the end of the treatment. Max: 25 mg twice a day. are immediate-release,* taken twice daily. and transmitted securely. 1990 Feb;30(S2):S61-5. Prescribers are encouraged to use the pharmacological diversity of beta-blockers and the clinical characteristics of patients to individualise treatment and optimise care. Created for people with ongoing healthcare needs but benefits everyone. 8 months and the mean daily dose of . that patients now gain less benefit from the use of beta-blockers than they did decades ago, There are no recent prospective randomised studies assessing the long-term benefits of beta-blockers in patients The difference between the mean ABPM observed in the last 24 hours at Week 12 and baseline was calculated to find out the change of mean ABPM at the end of the treatment. EH who are suitable for mono-therapy, either mild to moderate EH patients who have not been treated with anti-hypertension drugs, or mild EH subjects who have taken anti-hypertension drug. Side effects of Zebeta that are different from Bystolic include drowsiness, lightheadedness on standing, spinning sensation, dry mouth, vomiting, constipation, increased urination, runny or stuffy nose, ringing in your ears, weakness, depression, anxiety, restless feeling, joint or muscle pain, itching or skin rash, or loss of interest in sex. Recommended starting doses depend on the clinical scenario. The first dynamic blood pressure monitoring was used as baseline. Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01508325. 2014. -, Eur Heart J. Epub 2019 Apr 11. Take with food to slow the rate of absorption and decrease the risk of orthostatic effects. amlodipine. For metoprolol doses 100 mg (i.e., medium to high doses) and systolic blood pressure >100 mm Hg, carvedilol was started at 12.5 mg b.i.d. Anti-oxidants help prevent inflammatory conditions and lower blood pressure. The doses of metoprolol succinate and tartrate are slightly different due to the difference [2015 ESC Guidelines for the management of patients with ventricular heart failure or arrhythmias (see: The optimal duration of treatment Secondary end points included ambulatory monitoring of the BP and . Would you like email updates of new search results? Objective: Bisoprolol, carvedilol and nebivolol have been shown to be effective in the treatment of heart failure. University of Otago, Dr Linda Bryant, Clinical Advisory Pharmacist and Senior Lecturer, School of Pharmacy, University These include: Your email address will not be published. and may cause more bradycardia. Beta blockers may not work as effectively for black people and older people, especially when taken without other blood pressure medications. with the presence of co-morbidities, to individualise care for patients with cardiovascular conditions. angina, arrhythmia, heart failure, hypertension and post-myocardial infarction, it is Treatment with beta-blockers is generally long-term, but it should not be regarded as indefinite. Beta-blockers should be withdrawn slowly to prevent the onset of a withdrawal syndrome which in serious cases may include See also: bisoprolol side effects in more detail. Increase dose at intervals of 2 weeks. patients with insulin resistance, although strong evidence of a benefit is lacking.3 In addition to alpha1-blockade, Moderate EH patients who have used anti-hypertension drugs, Subjects with history of coronary heart disease, Cerebrovascular events within 6 months before screening, Impaired hepatic or renal function (according to local lab standard), Other protocol defined exclusion criteria could apply. Bethesda, MD 20894, Web Policies The dose of bisoprolol will be escalated to 7.5 mg orally once daily for next 4 weeks (Weeks 4 to 8) and to 10 mg orally once daily for the next 4 weeks (Weeks 8 to 12), if clinic systolic blood pressure (SBP) was greater than or equal to (>=) 140 millimeters of mercury (mmHg) and/or diastolic blood pressure (DBP) was >=90 mmHg measured every 4 weeks.