FOIA Lexi-Comp, Inc.; April 10, 2018. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. after myocardial infarction.11 Alternatives Finally mean heart rate was recorded. This can be increased to a maximum of 360 mg/day in divided doses. bisoprolol 5mg daily. For example, . The ABPM determined blood pressure 3 times hourly in the daytime and once hourly in the nighttime. Patients from seven centers in China were treated with either bisoprolol 5 mg or metoprolol CR/ZOK 47.5 mg once daily for 12 weeks. In conclusion, bisoprolol provided superior dynamic HR reduction and non-inferior dynamic BP reduction vs. metoprolol CR/ZOK in patients with mild-to-moderate hypertension. Garlic. No significant clinical decisions should be made based on these images from this website without first consulting with a board-certified attending physician. this increased risk continues for six months.25 Heart rate and blood pressure should be monitored as the are immediate-release,* taken twice daily. The ABPM determined blood pressure 3 times hourly in the daytime and once hourly in the nighttime. CSU Your reply, once signed off, will appear below the comment to which you replied of randomized trials. Beta-blockers reduced the risk of mortality and exacerbation in patients with COPD: a weeks 1-8 in total). (or into if currently out) all comment notification emails by clicking the button below. -, Cardiovasc Drugs Ther. The first dynamic daytime blood pressure monitoring was used as baseline. Pulse rate was measured by palpation on radial artery for 1 minute. Daily. in weight of the two salts, but they are therapeutically equivalent, e.g. A review of their pharmacodynamic and pharmacokinetic properties, and therapeutic use in hypertension and ischaemic heart disease. Unable to load your collection due to an error, Unable to load your delegates due to an error. From what my doctor told me, 12,5 mg of Metoprolol is similar . 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. Medicare statistics. Myocardial infarction: cardiac rehabilitation and prevention In Silico comparison between metoprolol succinate and bisoprolol on 24-hour systolic blood pressures. Is not subject to the Controlled Substances Act. You may Food can enhance the levels of metoprolol in your body. ; otherwise (i.e., for patients receiving low to medium . meta-analysis of observational studies. Bisoprolol has an average rating of Copyright 1993-2021 [2015 ESC Guidelines for the management of patients with ventricular which included 15 studies with a follow-up period ranging from one to seven years found that beta-blockers in patients preferred in patients with respiratory disease. Sotalol is used bisoprolol. For patients with uncomplicated hypertension beta-blockers are generally a fourth-line option as angiotensin converting Subjects received 10 mg bisoprolol, 50 mg carvedilol, 10 mg nebivolol and . Beta blockers may not work as effectively for black people and older people, especially when taken without other blood pressure medications. Tenormin (atenolol) is good for controlling chest pain and treating a heart attack. N Z Med J 2012;125:12247. Coll. Wiysonge CS, Bradley HA, Volmink J, et al. Two measurements were made at least 1 to 2 minutes apart. 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 However, if you were taking 25 mg of atenolol, it makes sense that you would be initiated on a low dose of metoprolol succinate, around 25 to 50 mg. The Task Force for the Management of Patients with Ventricular ACE inhibitors interfere with the conversion of . No new safety concerns were found. carvedilol, reduce peripheral resistance by binding to alpha-adrenoceptors, Adult. The first dynamic blood pressure monitoring was used as baseline. Elderly: Oral: Initial: 25 mg/day; usual range: 25-300 mg/day. Sotalol should be initiated and doses increased in a hospital with facilities for cardiac rhythm monitoring and assessment. Only monitoring data with valid data >=80% was used for analysis. Refer to the New Zealand Formulary for individual beta-blocker dosing regimens: Although these images are curated, as they are sourced from the community, there is no way to guarantee a consistent standard of accuracy and quality across the library of images. a starting dose of 23.75 mg metoprolol succinate may be appropriate for a patient with moderately It has fewer side effects than other beta blockers. View more, Metoprolol is a selective beta-blocker at dosages usually prescribed to lower blood pressure or relieve the symptoms of angina. exercise capacity. If you notice mild side effects, don't stop taking the beta-blocker without talking to your doctor first . The .gov means its official. The difference between the last 24 hours heart rate at Week 12 and of the baseline heart rate was calculated. At 612-months post-myocardial infarction prescribers are encouraged to consider withdrawing beta-blockers from patients . By working on the beta-1 receptor of the cardiac muscle cells, it yields both a chronotropic and inotropic effect. For secondary prevention of myocardial infarction, the evidence is best for timolol. bisoprolol and metoprolol, and adverse effects.22, There is evidence that beta-blockers are under-prescribed to patients with COPD, yet they provide significant benefit The first nighttime blood pressure monitoring was used as baseline. atenolol 50mg daily. -Blocker. A total of 186 patients, with 93 patients in each group, were enrolled and analyzed. Read our, Identifier: NCT01508325, Interventional It is likely that metoprolol succinate is the beta-blocker of choice among New Zealand prescribers because it has a two formulations is identical. You should take metoprolol at the same View side-by-side comparisons of medication uses, ratings, cost, side effects and interactions. The degree and duration of beta blockade appeared related to drug potency. if the patient develops lower limb ulcers. This website was made to assist in clinical knowledge recall and to supplement and support clinician judgement. The drug is selective for beta-1 receptors. Noncompliance was reported in 3 (3.53%) and 6 (7.32%) patients in the bisoprolol and metoprolol CR/ZOK groups, respectively. The initial dosage of metoprolol succinate ranges from 25-100 mg per day. Metoprolol and diltiazem are used to treat high blood pressure (hypertension), heart pain (angina), and abnormal heart rhythms. Beta blockers work by blocking the effects of the hormone epinephrine, also called adrenaline. to those with co-existing heart failure;23 cardioselective beta-blockers are preferred. by bisoprolol or metoprolol succinate. prescription would be due. 3 5% of patients can be expected to be intolerant to beta-blocker treatment due to hypotension or bradycardia.20. with heart failure. it was found that sotalol was associated with a higher rate of sudden death when administered to patients Hypertension: Oral: 25-50 mg once daily, may increase to 100 mg/day. The better beta blocker will be the one that works best for you. 1990 Feb;30(S2):S66-71. review and meta-analysis of randomized controlled trials. Carvedilol. Oprolols: Bisoprolol and metoprolol are both beta blockers. Both medications significantly reduce the risk of another heart attack from occurring, and there are no obvious differences between the 2 on this front. Patients with heart failure with preserved ejection fraction (HF-PEF) may also be prescribed a beta-blocker if they official website and that any information you provide is encrypted ''bisoprolol vs. carvedilol'', ''bisoprolol vs. metoprolol succinate'', and ''carvedilol vs. metoprolol succinate'' as dependent variables. block and stimulate beta-adrenoceptors causing less bradycardia and peripheral vasoconstriction.5 This may -, Am J Hypertens. Bisoprolol: Dosing of bisoprolol for patients with congestive heart failure is best guided by the CIBIS II dosing protocol. Adult. Clinical outcomes with -blockers for myocardial infarction: a meta-analysis Am J Med 2014;127:93953. Gynaecology and urinary tract disorders (female), Integrated Performance and Incentive Framework,,, The optimal duration of treatment atenolol, celiprolol or nadolol. swelling and fluid retention, along with weight gain. 3.6 / 5 average rating with 457 reviews forAtenolol. 2023 The Regents of the University of California. - Select active agent 1 - Metoprolol Atenolol Bisoprolol Nebivolol Propranolol Sotalol. e.g. Doctors usually prescribe beta-blockers to treat cardiovascular conditions such as angina and hypertension, which is also known as high blood pressure. Yancy C, Jessup M, Bozkurt B, et al. Saffron. Federal government websites often end in .gov or .mil. CSA Schedule ** View glossary of terms ST-elevation myocardial infarction: New Zealand Management Guidelines, 2013. A practical approach would be to reduce the patients Bryant: However, the beta-blocking effects of these drugs have never been compared directly. A cardioselective beta-blocker such as bisoprolol Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology]. of Otago and Leanne Te Karu, Pharmacist Prescriber and Associate Dean, School of Pharmacy, University of Otago for expert review of this article. 2016. These medications work by preventing the heart rate from going too high. Beta blockers arent usually prescribed for high blood pressure unless other medications, such as diuretics, havent worked effectively. Bookshelf Take with food to slow the rate of absorption and decrease the risk of orthostatic effects. Bangalore S, Makani H, Radford M, et al. carvedilol or 100 mg metoprolol. emergence of co-morbidities may make management more complex and it is appropriate to periodically review the benefits dosed once-daily and it is cardioselective (see below). Consider TID or BID dosing with IR or ER formulation, based on resident pain level. dose is reduced and the patients cardiac receptors and sympathetic nerve activity down-regulate.3, 26. You can use beta-blockers for extended periods. has declined since the SWORD (survival with oral d-sotalol) study in the 1990s was discontinued when Pulse rate was measured by palpation on radial artery for 1 minute. Third, we estimated a risk score for . Treatment with beta-blockers is generally long-term, but it should not be regarded as indefinite. Beta blockers equivalent dosing. Results: Metoprolol tended to decrease heart rate during exercise (-21%, -25% and -24%) to a greater extent than carvedilol (-16%, -16% and -18%). to persist with treatment as long as their systolic blood pressure does not fall too low, e.g. Your doctor will choose which beta blocker is best for you based on your health conditions. Brand names: Cardicor, Congescor. Tolerance to treatment with better outcomes.13 Beta-blockers may be more effective in younger patients with hypertension than older Pindolol 5mg BID. should also be withdrawn slowly, ideally over several months, to prevent rebound symptoms such as resting The mean change in the blood pressure variability between the 24-hour blood pressure observed at Week 12 and baseline was calculated. wide range of indications, i.e. No significant clinical decisions should be made based on these images from this website without first consulting with a board-certified attending physician. Information on the management of stable angina is available from: Beta-blockers should generally be avoided in patients with asthma.21 This is because they may prevent sympathetic more. The benefits of beta-blockers post-myocardial infarction are also no longer Pulse rate was measured by palpation on radial artery for 1 minute. Occasionally it may Bisoprolol or metoprolol; consider withdrawal after 6-12 months if re-vascularised and no other indications. less than 100 mmHg. Thank. in Collaboration With EACTS. and New Zealand. infarction is increased for older patients during the first month of withdrawal from cardioselective beta-blockers and A 200 mg modified-release form of metoprolol tartrate, taken once daily, is available fully subsidised in New Zealand. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. celiprolol and pindolol. Beta Blocker approximate dose equivalents Carvedilol 12.5 mg BlD Labetalol 100 mg BID Atenolol 50 mg daily Bisoprolol 5 mg daily Propranolol . Leafy green vegetables. for rhythm control include flecainide in younger patients or amiodarone in older patients. First of all, they differ in the time of action of the drug. As mentioned, most patients can be initially switched to 6.25 mg or 12.5 mg b.i.d. The role of the new beta-blockers in treating cardiovascular disease. Research is ongoing into the complex ways in which these properties translate into treatment effects for patients. The risk of myocardial are generally prescribed for heart failure in New Zealand; there is no strong evidence of effectiveness for one in different cardiovascular conditions and co-morbidities is therefore timely. The top 9 with the exception of Bystolic are all generic and therefore relatively inexpensive. Cardiovasc Drugs Ther. 40% of reviewers reported a positive effect, while 34% reported a negative effect. By mouth using immediate-release medicines. Metoprolol, sold under the brand name Lopressor, among others, is a selective 1 receptor blocker medication. Prescribed for Supraventricular Copyright 2021 GlobalRPH - Web Development by, Drug Comparisons Beta Blockers equivalent doses, HONcode standard for trust- worthy health, Pediatric Oncology: Diagnosis And Prognosis Communication. Bisoprolol is lipophilic and hydrophilic. From 6-12 months onwards post-myocardial infarction, consider withdrawing beta-blockers for patients without heart There are no specific guidelines for withdrawing beta-blockers. Thank you to Associate Professor Gerard Wilkins, Consultant Cardiologist, Dunedin School of Medicine, Newer beta blockers, such as carvedilol (Coreg), dont usually cause weight gain as a side effect. rapidly. 500 mg QID/q6h. the threshold for ventricular arrhythmias, and in the long-term, to prevent dysfunctional ventricular remodelling and Metoprolol and Bisoprolol. Although these images are curated, as they are sourced from the community, there is no way to guarantee a consistent standard of accuracy and quality across the library of images. ; 97.5% confidence interval (CI): -7.45, -0.14; P=0.0202). Last Modified: May 11, 2016. If the patients were taking beta-blockers other than carvedilol, their dose will be calculated into the equivalent dose of carvedilol . Switching initially was done between patients receiving doses of 25 mg carvedilol and 100 mg metoprolol. 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. 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. Sotalol should not be used for rate control in atrial fibrillation due to its pro-arrhythmic action. and co-morbidities, e.g. Epub 2019 Apr 11. The equivalent dose of sustained release verapamil can be used once per day or divided into twice a day to better maintain . highlights the risk of depending on one beta-blocker. Available from: National Institute for Health and Care Excellence (NICE). Careers. Atenolol and bisoprolol are both beta-blockers and are used to help treat high blood pressure, angina and heart failure. Table 2: Summary of indications, recommendations and considerations for the use of beta-blockers for cardiovascular conditions in New Zealand. for their myocardial infarction. with uncomplicated myocardial infarction. 2021 Sep 17. doi: 10.1007/s10557-021-07248-1. 2016 ESC Guidelines for the Management of Atrial Fibrillation Developed Acebutolol 100 mg PO BID. 19 hours. -, Eur Heart J. Pharmaceutical Claims Collection. Begin treatment with a beta-blocker at a low dose and gradually increase this to the recommended dose or the maximum atenolol, are excreted via the kidneys and dose reductions may be necessary in patients 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 . Table 1: Properties of beta-blockers subsidised in New Zealand. beta-blockers, but there is evidence of benefit for a number of other beta-blockers and international guidelines do not arrhythmias and the prevention of sudden cardiac Death. Information on the management of acute coronary syndromes is available from: Possible alternatives to metoprolol succinate for treating heart failure include bisoprolol and carvedilol. Metoprolol and hydrochlorothiazide (50 mg/25 mg, 100 mg/25 mg, 100 mg/50 mg) . Beta Blocker Conversion Table. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction. View more. have other cardiovascular co-morbidities, such as atrial fibrillation or hypertension.12, Information on the management of heart failure is available from: Nebivolol Vs. Metoprolol: Comparative Effects on Fatigue and Quality of Life: Study Start Date : October 2009: Actual . are better tolerated than non-selective beta-blockers, although they are still associated with a decrease in lung function Only monitoring data with valid data greater than or equal to (>=) 80 percent (%) was used for analysis. All Approximately Equivalent Doses Reasonable for Substitution in Most Cases. carvedilol, also bind to alpha-adrenoceptors and prevent contraction of vascular smooth muscle. Long-term beta blockers for stable angina: systematic review and meta-analysis. Brand Names: N/A. *Disclaimer: These are not typical starting doses. Adult. Am. Metoprolol has an average rating of e.g. View this study on, 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. Atenolol. 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. Prescribers are encouraged to use the pharmacological diversity of beta-blockers and the clinical characteristics of patients to individualise treatment and optimise care. Eur J Cardiothorac Surg 2016;50:e1-88. Elderly: Age does not significantly alter the pharmacokinetics of sotalol, but impaired renal function in elderly patients can increase the terminal half-life, resulting in increased drug accumulation. 8600 Rockville Pike 25 After 20 minutes, the acute vitamin C infusion was maintained at the same rate while the bradykinin and sodium . Beta-blockers are initiated alongside an ACE inhibitor in all patients with heart failure with reduced ejection fraction 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 easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. According to studies, carvedilol and metoprolol are just as good at improving the chances of survival after a heart attack. from: National Institute for Health and Care Excellence (NICE). Zealand before alternative options, e.g. metoprolol succinate 23.75 mg is equal to metoprolol and increasingly the evidence appears to support the withdrawal of beta-blockers from patients without other indications Secondary end points included ambulatory monitoring of the BP and . for the treatment of heart failure, beta-blockers now have a limited role in the treatment of hypertension and are routinely Infusion may be continued at 50 mcg/kg/minute or, if the response is inadequate, titrated upward in 50 mcg/kg/minute increments (increased no more frequently than every 4 minutes) to a maximum of 200 mcg/kg/minute. propranolol, block beta1 and beta2-adrenoceptors equally. that are less likely to cause fatigue and cold extremities than non-specific beta-blockers and are often Primary outcome measure was . Guidelines support the use of a beta-blocker for one to three years post-myocardial infarction,18, 19 but from: Morales DR, Jackson C, Lipworth BJ, et al. Bisoprolol. Beta blockers can also affect your cholesterol and triglyceride levels. Record the patients heart rate and blood pressure before treatment is initiated and continue to monitor Dosage Form(s) Available: Oral tablet; N/A. See also: bisoprolol side effects in more detail. Metoprolol (Lopressor)* 2.5 to 5 mg IV bolus over 2 minutes, up to 3 doses . m not sure if there is a chart for comparing beta blockers, but as far as I know, bisoprolol (Emconcor) is about 20 times as strong as Metoprolol, so 1,25 mg of bisoprolol is approx. HHS Vulnerability Disclosure, Help Max: 25 mg twice a day. Metoprolol is a selective beta-blocker at dosages usually prescribed to lower blood pressure or relieve the symptoms of angina. In general, you should call or schedule an appointment if you have a sudden change in symptoms, especially ones related to your heart and circulatory system. Only monitoring data with valid data >=80% was used for analysis. Available Catheter Cardiovasc Interv 2013;82:E1-27. 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. 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. the dose to every second day for another month, before stopping treatment completely at the time when the patients next 20mg/day (HTN) 10mg/day (HF) Disclaimer: Starting doses and titration schedule depend on individual clinical scenario and are particularly important to review with renal failure that may have different starting dose recommendations*. Carvedilol may lower blood pressure more than metoprolol. 2013 Jul;34(28):2159-219 Find out how bisoprolol treats high blood pressure (hypertension) and heart failure, and how to take it. Would you like email updates of new search results? dose over several months, e.g. They have subtle differences but basically do the same things. The data showed that the addition of a beta-blocker to thiazide diuretics or calcium channel blockers reduced BP by 8/6 mmHg when given at doses 2 times the recommended starting dose. failure or arrhythmias, if re-vascularisation has occurred, Bisoprolol is an alternative to metoprolol succinate in many cases; both are once-daily cardioselective beta-blockers If Metoprolol succinate may cost between $14 and $44 for a one-month supply, while metoprolol tartrate may cost anywhere from $4 to $18 . Esmolol. Johns Hopkins Guides. exclusively for rhythm control in patients with supraventricular and ventricular arrhythmias, but use Bethesda, MD 20894, Web Policies Metoprolol 50 mg PO BID [immediate release] They can cause a slight rise in triglycerides, a type of fat in your blood, and a modest decrease in good cholesterol, or high-density lipoprotein (HDL) cholesterol. Patients receiving betablockers other than . . Acetaminophen (Tylenol) four times daily to less frequent dosing or conversion to acetaminophen extended release (Tylenol ER) 325 mg QID/q6h. Beta-blockers or calcium channel blockers are recommended as the first-line anti-anginal medicines.7 There Cardiovasc Drugs Ther. Description. cold extremities or fatigue, Celiprolol and pindolol have ISA which may reduce bradycardia or peripheral vasoconstriction, Water soluble beta-blockers, e.g. Commonly reported side effects include: See also: metoprolol side effects in more detail. Pulses. 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. Calculation of equivalent doses of antihypertensive drugs. 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. For this non-overlapping or abrupt switching, the current blocker should be discontinued approximately 12 hours before the first dose of carvedilol. Beta-blockers: their properties and use in hypertension. Originally widely prescribed for hypertension and contraindicated You can't miss doses. 2.3k views Reviewed >2 years ago. 2.5 mg. 2.5-10mg. 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. in the elderly. In people who have diabetes, beta blockers may block signs of low blood sugar, such as rapid heartbeat. chest pain, even in those with no history of coronary heart disease. The dose of metoprolol will be escalated to 71.25 mg orally once daily for next 4 weeks (Weeks 4 to 8) and to 95 mg orally once daily for the next 4 weeks (Weeks 8 to 12) if clinic SBP was >=140 mmHg and/or DBP was >=90 mmHg measured every 4 weeks. In addition, the appropriate dosage . Data sources include IBM Watson Micromedex (updated 5 Feb 2023), Cerner Multum (updated 22 Feb 2023), ASHP (updated 12 Feb 2023) and others. J Clin Pharm Ther. Doses >100 mg are unlikely to produce any further benefit. Bisoprolol (Zebeta) Esmolol (Brevibloc injection) Metoprolol tartrate (Lopressor) Metoprolol succinate (Toprol XL) Nebivolol . Atenolol 50 mg PO DAILY. 2013. bisoprolol, were subsidised. All beta-blockers are considered to be equally effective (as fourth-line treatment) Post-myocardial infarction. 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). Cardioselective beta-blockers, e.g. tartrate 25 mg. We have now added the ability to add replies to a comment. the reperfusion era.17 Beta-blockers in the reperfusion era do, however, reduce the risk of subsequent angina propranolol 40mg BID. Subjects with contraindications according to the China Summary of Product Characteristics (SmPCs) of both bisoprolol and metoprolol SR, such as acute heart failure, second or third degree atrioventricular block (without a pacemaker), sick sinus syndrome, symptomatic bradycardia or symptomatic hypotension, severe bronchial asthma or severe chronic obstructive pulmonary disease, metabolic acidosis, etc. Your healthcare provider can advise you on when you should call or schedule an appointment related to taking beta-blockers. Two measurements were made at least 1 to 2 minutes apart. Subscribe to newsletters for the latest medication news, new drug approvals, alerts and updates. Blood pressure response rate was calculated as: number of subjects with blood pressure response divided by total number of subjects and multiplied by 100. Bananas. Bisoprolol or metoprolol; consider withdrawal after 612 months if re-vascularised and no other indications. . with the presence of co-morbidities, to individualise care for patients with cardiovascular conditions.