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Don Poldermans - One of the best experts on this subject based on the ideXlab platform.

  • Bisoprolol reduces cardiac death and myocardial infarction in high risk patients as long as 2 years after successful major vascular surgery
    European Heart Journal, 2001
    Co-Authors: Don Poldermans, Eric Boersma, Ian R Thomson, Bernard P Paelinck, M G Scheffer, Giuseppe Trocino, Carlo Vigna, H F Baars, J R T C Roelandt
    Abstract:

    Aim To assess the long-term cardioprotective effect of Bisoprolol in a randomized high-risk population after successful major vascular surgery. High-risk patients were defined by the presence of one or more cardiac risk factor(s) and a dobutamine echocardiography test positive for ischaemia. Methods 1351 patients were screened prior to surgery, 846 patients had one or more risk factor(s), and 173 of these patients also had ischaemia during dobutamine echocardiography. One hundred and twelve patients could be randomized for additional Bisoprolol therapy or standard care. Eleven patients died in the peri-operative period (up to 1 month after surgery). Randomized patients continued Bisoprolol or standard care after surgery. During follow-up of 101 survivors (median 22 months, range 11–30) cardiac death or myocardial infarction was noted. No patient was lost during follow-up. Results The incidence of cardiac events during follow-up in the Bisoprolol group was 12% vs 32% in the standard care group ( P =0·025). Cardiac death occurred in 15 patients, nine patients in the standard care and in six in the Bisoprolol group; myocardial infarction occurred in six patients, five in the standard care and one in the Bisoprolol group. The odds ratio for cardiac death or myocardial infarction after surgery in high-risk patients with additional Bisoprolol therapy was 0·30 (0·11–0·83). Conclusions Bisoprolol significantly reduced long-term cardiac death and myocardial infarction in high-risk patients after successful major cardiac vascular surgery.

  • Bisoprolol reduces cardiac death and myocardial infarction in high risk patients as long as 2 years after successful major vascular surgery
    European Heart Journal, 2001
    Co-Authors: Don Poldermans, L L M Van De Ven, Eric Boersma, Ian R Thomson, Bernard P Paelinck, M G Scheffer, Giuseppe Trocino, Carlo Vigna, Jeroen J Bax, H F Baars
    Abstract:

    Aim To assess the long-term cardioprotective effect of Bisoprolol in a randomized high-risk population after successful major vascular surgery. High-risk patients were defined by the presence of one or more cardiac risk factor(s) and a dobutamine echocardiography test positive for ischaemia. Methods 1351 patients were screened prior to surgery, 846 patients had one or more risk factor(s), and 173 of these patients also had ischaemia during dobutamine echocardiography. One hundred and twelve patients could be randomized for additional Bisoprolol therapy or standard care. Eleven patients died in the peri-operative period (up to 1 month after surgery). Randomized patients continued Bisoprolol or standard care after surgery. During follow-up of 101 survivors (median 22 months, range 11–30) cardiac death or myocardial infarction was noted. No patient was lost during follow-up. Results The incidence of cardiac events during follow-up in the Bisoprolol group was 12% vs 32% in the standard care group ( P =0·025). Cardiac death occurred in 15 patients, nine patients in the standard care and in six in the Bisoprolol group; myocardial infarction occurred in six patients, five in the standard care and one in the Bisoprolol group. The odds ratio for cardiac death or myocardial infarction after surgery in high-risk patients with additional Bisoprolol therapy was 0·30 (0·11–0·83). Conclusions Bisoprolol significantly reduced long-term cardiac death and myocardial infarction in high-risk patients after successful major cardiac vascular surgery.

  • the effect of Bisoprolol on perioperative mortality and myocardial infarction in high risk patients undergoing vascular surgery
    The New England Journal of Medicine, 1999
    Co-Authors: Don Poldermans, L L M Van De Ven, Eric Boersma, Ian R Thomson, Giuseppe Trocino, Carlo Vigna, H F Baars, Jeroen J Bax, J D Blankensteijn, J R T C Roelandt
    Abstract:

    Background Cardiovascular complications are the most important causes of perioperative morbidity and mortality among patients undergoing major vascular surgery. Methods We performed a randomized, multicenter trial to assess the effect of perioperative blockade of beta-adrenergic receptors on the incidence of death from cardiac causes and nonfatal myocardial infarction within 30 days after major vascular surgery in patients at high risk for these events. High-risk patients were identified by the presence of both clinical risk factors and positive results on dobutamine echocardiography. Eligible patients were randomly assigned to receive standard perioperative care or standard care plus perioperative beta-blockade with Bisoprolol. Results A total of 1351 patients were screened, and 846 were found to have one or more cardiac risk factors. Of these 846 patients, 173 had positive results on dobutamine echocardiography. Fifty-nine patients were randomly assigned to receive Bisoprolol, and 53 to receive standard care. Fifty-three patients were excluded from randomization because they were already taking a beta-blocker, and eight were excluded because they had extensive wall-motion abnormalities either at rest or during stress testing. Two patients in the Bisoprolol group died of cardiac causes (3.4 percent), as compared with nine patients in the standard-care group (17 percent, P=0.02). Nonfatal myocardial infarction occurred in nine patients given standard care only (17 percent) and in none of those given standard care plus Bisoprolol (P Conclusions Bisoprolol reduces the perioperative incidence of death from cardiac causes and nonfatal myocardial infarction in high-risk patients who are undergoing major vascular surgery.

Philippe Lechat - One of the best experts on this subject based on the ideXlab platform.

  • improved survival with Bisoprolol in patients with heart failure and renal impairment an analysis of the cardiac insufficiency Bisoprolol study ii cibis ii trial
    European Journal of Heart Failure, 2010
    Co-Authors: Davide Castagno, Pardeep S Jhund, John J V Mcmurray, James Lewsey, Erland Erdmann, Faiez Zannad, Willem J Remme, Jose Lopezsendon, Philippe Lechat
    Abstract:

    Aims Information on the effectiveness of beta-blockade in patients with heart failure (HF) and concomitant renal impairment is scarce and beta-blockers are underutilized in these patients. Methods and results The Cockcroft–Gault formula normalized for body surface-area was used to estimate renal function (eGFRBSA) in 2622 patients with HF, left ventricular ejection fraction ≤35%, New York Heart Association class III/IV and serum creatinine <300 μmol/L (3.4 mg/dL) in the second Cardiac Insufficiency Bisoprolol Study II. Patients were divided into four sub-groups according to baseline eGFRBSA (<45, 45–60, 60–75 and ≥75 mL/min per 1.73 m2). Cox proportional-hazards models adjusted for pre-specified confounders were used to assess the effect of Bisoprolol and potential heterogeneity of effect across the eGFRBSA sub-groups. Older age, female-sex, diabetes and ischaemic-aetiology were more common in those with reduced eGFRBSA. The hazard associated with Bisoprolol use for all-cause mortality, the composite of all-cause mortality or HF-hospitalization and HF-hospitalization alone was consistently <1.0 across eGFRBSA categories with no treatment by renal-function interaction (P = 0.81, P = 0.66, P = 0.71, respectively). The rate of Bisoprolol discontinuation was higher in patients with eGFRBSA < 45 mL/min per 1.73 m2. Nevertheless the absolute benefit of Bisoprolol was greater for patients with chronic kidney disease compared with those without. Conclusion The beneficial effects of Bisoprolol on mortality and hospitalization for worsening heart-failure were not modified by baseline eGFRBSA. Renal impairment should not prevent the use of Bisoprolol in patients with HF.

  • Bisoprolol for the treatment of chronic heart failure a meta analysis on individual data of two placebo controlled studies cibis and cibis ii
    American Heart Journal, 2002
    Co-Authors: Alain Leizorovicz, Philippe Lechat, Michel Cucherat, Francoise Bugnard
    Abstract:

    Abstract Background Despite the available evidence from randomized clinical trials, β-blockers are often not used optimally in patients with congestive heart failure (CHF). This meta-analysis aims at providing a precise and quantitative estimate of the benefit and risks of long-term Bisoprolol on major clinical events in patients with CHF, both overall and in selected subgroups. This may help clinicians in their decisions as to whether to prescribe Bisoprolol for their individual patients. Methods Meta-analysis was performed of results from the 2 randomized, controlled clinical studies in which Bisoprolol was compared with placebo (Cardiac Insufficiency Bisoprolol Study [CIBIS and CIBIS II]), which included 3288 patients with proven CHF. The main outcomes were total death, cardiovascular death, sudden death, hospitalization for heart failure, and myocardial infarction. Results A highly significant 29.3% relative reduction of death (17%, 40%; P =.00003) was observed, as well as significant risk reduction in cardiovascular death and sudden death in favor of Bisoprolol. Also, a highly significant relative reduction of 18.4% (25%, 11%; P =.00001) in hospital admission or death was observed. A similar relative reduction of death was consistently observed in selected subgroups of patients. Conclusions Bisoprolol prevents major cardiovascular events in patients with CHF with a high benefit-to-risk ratio and can be recommended for these patients. (Am Heart J 2002;143:301-7.)

  • effects of β blockade with Bisoprolol on heart rate variability in advanced heart failure analysis of scatterplots of r r intervals at selected heart rates
    American Heart Journal, 1996
    Co-Authors: Xavier Copie, Philippe Lechat, Francoise Pousset, Patrice Jaillon, Louis Guize, Jeanyves Le Heuzey
    Abstract:

    The effect of beta-blockade on heart-rate variability was assessed at different heart rates in 52 patients with heart failure included in the randomized, placebo-controlled, Cardiac Insufficiency Bisoprolol Study (CIBIS). Scatterplots of R-R intervals display beat-to-beat variability by plotting each R-R interval against the preceding interval. Scatterplot dispersion at different R-R intervals provides a measure of beat-to-beat heart-rate variability at different heart rates. A 24-hour Holter tape was performed at baseline and after 2 months of treatment with Bisoprolol or matched placebo. Geometric measurements of scatterplots were used to determine beat-to-beat dispersion for different R-R intervals. Bisoprolol and placebo groups were well matched at base-line. After 2 months of treatment, Bisoprolol significantly increased beat-to-beat variability at the longest R-R intervals (p < 0.05); however, there was no change in scatterplot dispersion at the shortest R-R intervals. This suggests that beta-blockade increases parasympathetic or decreases sympathetic tone or both in heart failure patients only at the slowest heart rates.

  • effects of Bisoprolol on heart rate variability in heart failure
    American Journal of Cardiology, 1996
    Co-Authors: Francoise Pousset, Willem J Remme, Philippe Lechat, Xavier Copie, Patrice Jaillon, Louis Guize, Jeanpierre Boissel, Martin Hetzel, Frederic Fillette, Jeanyves Le Heuzey
    Abstract:

    Analysis of heart rate variability (HRV) provides a non-invasive index of autonomic nervous system activity. HRV has been shown to be reduced in heart failure. Preliminary data indicate that beta blockers improve clinical status in patients with heart failure, but HRV improvement remains to be demonstrated. Fifty-four patients from the randomized double-blind, placebo-controlled Cardiac Insufficiency Bisoprolol Study were included in the HRV study. The Bisoprolol daily dose was 5 mg once daily. We assessed HRV during 24-hour Holter recordings before randomization and after 2 months of treatment. HRV as measured in the time domain by root-mean-square successive differences (rMSSD), the percentage of adjacent RR differences >50 ms (pNN50), and the SD of RR intervals (SDNN), and in the frequency domain by high-frequency (0.16 to 0.40 Hz) and low-frequency (0.04 to 0.15 Hz) power. Most patients were in New York Heart Association functional class III. The mean left ventricular ejection fraction was 27 +/- 7%, and heart failure was idiopathic or ischemic. After 2 months, the patients receiving Bisoprolol had a reduced mean heart rate compared with that in placebo patients (p=0.0004). Bisoprolol increased 24-hour rMSSD (p=0.04) and 24-hour pNN50 (p=0.04), daytime SDNN (p=0.05), and daytime high-frequency power (p=0.03) power. Bisoprolol induced a significant increase in HRV parameters related to parasympathetic activity in heart failure. Increased vagal tone may contribute to the protective effect of beta blockers and may have prognostic implications.

J R T C Roelandt - One of the best experts on this subject based on the ideXlab platform.

  • Bisoprolol reduces cardiac death and myocardial infarction in high risk patients as long as 2 years after successful major vascular surgery
    European Heart Journal, 2001
    Co-Authors: Don Poldermans, Eric Boersma, Ian R Thomson, Bernard P Paelinck, M G Scheffer, Giuseppe Trocino, Carlo Vigna, H F Baars, J R T C Roelandt
    Abstract:

    Aim To assess the long-term cardioprotective effect of Bisoprolol in a randomized high-risk population after successful major vascular surgery. High-risk patients were defined by the presence of one or more cardiac risk factor(s) and a dobutamine echocardiography test positive for ischaemia. Methods 1351 patients were screened prior to surgery, 846 patients had one or more risk factor(s), and 173 of these patients also had ischaemia during dobutamine echocardiography. One hundred and twelve patients could be randomized for additional Bisoprolol therapy or standard care. Eleven patients died in the peri-operative period (up to 1 month after surgery). Randomized patients continued Bisoprolol or standard care after surgery. During follow-up of 101 survivors (median 22 months, range 11–30) cardiac death or myocardial infarction was noted. No patient was lost during follow-up. Results The incidence of cardiac events during follow-up in the Bisoprolol group was 12% vs 32% in the standard care group ( P =0·025). Cardiac death occurred in 15 patients, nine patients in the standard care and in six in the Bisoprolol group; myocardial infarction occurred in six patients, five in the standard care and one in the Bisoprolol group. The odds ratio for cardiac death or myocardial infarction after surgery in high-risk patients with additional Bisoprolol therapy was 0·30 (0·11–0·83). Conclusions Bisoprolol significantly reduced long-term cardiac death and myocardial infarction in high-risk patients after successful major cardiac vascular surgery.

  • the effect of Bisoprolol on perioperative mortality and myocardial infarction in high risk patients undergoing vascular surgery
    The New England Journal of Medicine, 1999
    Co-Authors: Don Poldermans, L L M Van De Ven, Eric Boersma, Ian R Thomson, Giuseppe Trocino, Carlo Vigna, H F Baars, Jeroen J Bax, J D Blankensteijn, J R T C Roelandt
    Abstract:

    Background Cardiovascular complications are the most important causes of perioperative morbidity and mortality among patients undergoing major vascular surgery. Methods We performed a randomized, multicenter trial to assess the effect of perioperative blockade of beta-adrenergic receptors on the incidence of death from cardiac causes and nonfatal myocardial infarction within 30 days after major vascular surgery in patients at high risk for these events. High-risk patients were identified by the presence of both clinical risk factors and positive results on dobutamine echocardiography. Eligible patients were randomly assigned to receive standard perioperative care or standard care plus perioperative beta-blockade with Bisoprolol. Results A total of 1351 patients were screened, and 846 were found to have one or more cardiac risk factors. Of these 846 patients, 173 had positive results on dobutamine echocardiography. Fifty-nine patients were randomly assigned to receive Bisoprolol, and 53 to receive standard care. Fifty-three patients were excluded from randomization because they were already taking a beta-blocker, and eight were excluded because they had extensive wall-motion abnormalities either at rest or during stress testing. Two patients in the Bisoprolol group died of cardiac causes (3.4 percent), as compared with nine patients in the standard-care group (17 percent, P=0.02). Nonfatal myocardial infarction occurred in nine patients given standard care only (17 percent) and in none of those given standard care plus Bisoprolol (P Conclusions Bisoprolol reduces the perioperative incidence of death from cardiac causes and nonfatal myocardial infarction in high-risk patients who are undergoing major vascular surgery.

H F Baars - One of the best experts on this subject based on the ideXlab platform.

  • Bisoprolol reduces cardiac death and myocardial infarction in high risk patients as long as 2 years after successful major vascular surgery
    European Heart Journal, 2001
    Co-Authors: Don Poldermans, Eric Boersma, Ian R Thomson, Bernard P Paelinck, M G Scheffer, Giuseppe Trocino, Carlo Vigna, H F Baars, J R T C Roelandt
    Abstract:

    Aim To assess the long-term cardioprotective effect of Bisoprolol in a randomized high-risk population after successful major vascular surgery. High-risk patients were defined by the presence of one or more cardiac risk factor(s) and a dobutamine echocardiography test positive for ischaemia. Methods 1351 patients were screened prior to surgery, 846 patients had one or more risk factor(s), and 173 of these patients also had ischaemia during dobutamine echocardiography. One hundred and twelve patients could be randomized for additional Bisoprolol therapy or standard care. Eleven patients died in the peri-operative period (up to 1 month after surgery). Randomized patients continued Bisoprolol or standard care after surgery. During follow-up of 101 survivors (median 22 months, range 11–30) cardiac death or myocardial infarction was noted. No patient was lost during follow-up. Results The incidence of cardiac events during follow-up in the Bisoprolol group was 12% vs 32% in the standard care group ( P =0·025). Cardiac death occurred in 15 patients, nine patients in the standard care and in six in the Bisoprolol group; myocardial infarction occurred in six patients, five in the standard care and one in the Bisoprolol group. The odds ratio for cardiac death or myocardial infarction after surgery in high-risk patients with additional Bisoprolol therapy was 0·30 (0·11–0·83). Conclusions Bisoprolol significantly reduced long-term cardiac death and myocardial infarction in high-risk patients after successful major cardiac vascular surgery.

  • Bisoprolol reduces cardiac death and myocardial infarction in high risk patients as long as 2 years after successful major vascular surgery
    European Heart Journal, 2001
    Co-Authors: Don Poldermans, L L M Van De Ven, Eric Boersma, Ian R Thomson, Bernard P Paelinck, M G Scheffer, Giuseppe Trocino, Carlo Vigna, Jeroen J Bax, H F Baars
    Abstract:

    Aim To assess the long-term cardioprotective effect of Bisoprolol in a randomized high-risk population after successful major vascular surgery. High-risk patients were defined by the presence of one or more cardiac risk factor(s) and a dobutamine echocardiography test positive for ischaemia. Methods 1351 patients were screened prior to surgery, 846 patients had one or more risk factor(s), and 173 of these patients also had ischaemia during dobutamine echocardiography. One hundred and twelve patients could be randomized for additional Bisoprolol therapy or standard care. Eleven patients died in the peri-operative period (up to 1 month after surgery). Randomized patients continued Bisoprolol or standard care after surgery. During follow-up of 101 survivors (median 22 months, range 11–30) cardiac death or myocardial infarction was noted. No patient was lost during follow-up. Results The incidence of cardiac events during follow-up in the Bisoprolol group was 12% vs 32% in the standard care group ( P =0·025). Cardiac death occurred in 15 patients, nine patients in the standard care and in six in the Bisoprolol group; myocardial infarction occurred in six patients, five in the standard care and one in the Bisoprolol group. The odds ratio for cardiac death or myocardial infarction after surgery in high-risk patients with additional Bisoprolol therapy was 0·30 (0·11–0·83). Conclusions Bisoprolol significantly reduced long-term cardiac death and myocardial infarction in high-risk patients after successful major cardiac vascular surgery.

  • the effect of Bisoprolol on perioperative mortality and myocardial infarction in high risk patients undergoing vascular surgery
    The New England Journal of Medicine, 1999
    Co-Authors: Don Poldermans, L L M Van De Ven, Eric Boersma, Ian R Thomson, Giuseppe Trocino, Carlo Vigna, H F Baars, Jeroen J Bax, J D Blankensteijn, J R T C Roelandt
    Abstract:

    Background Cardiovascular complications are the most important causes of perioperative morbidity and mortality among patients undergoing major vascular surgery. Methods We performed a randomized, multicenter trial to assess the effect of perioperative blockade of beta-adrenergic receptors on the incidence of death from cardiac causes and nonfatal myocardial infarction within 30 days after major vascular surgery in patients at high risk for these events. High-risk patients were identified by the presence of both clinical risk factors and positive results on dobutamine echocardiography. Eligible patients were randomly assigned to receive standard perioperative care or standard care plus perioperative beta-blockade with Bisoprolol. Results A total of 1351 patients were screened, and 846 were found to have one or more cardiac risk factors. Of these 846 patients, 173 had positive results on dobutamine echocardiography. Fifty-nine patients were randomly assigned to receive Bisoprolol, and 53 to receive standard care. Fifty-three patients were excluded from randomization because they were already taking a beta-blocker, and eight were excluded because they had extensive wall-motion abnormalities either at rest or during stress testing. Two patients in the Bisoprolol group died of cardiac causes (3.4 percent), as compared with nine patients in the standard-care group (17 percent, P=0.02). Nonfatal myocardial infarction occurred in nine patients given standard care only (17 percent) and in none of those given standard care plus Bisoprolol (P Conclusions Bisoprolol reduces the perioperative incidence of death from cardiac causes and nonfatal myocardial infarction in high-risk patients who are undergoing major vascular surgery.

L L M Van De Ven - One of the best experts on this subject based on the ideXlab platform.

  • Bisoprolol reduces cardiac death and myocardial infarction in high risk patients as long as 2 years after successful major vascular surgery
    European Heart Journal, 2001
    Co-Authors: Don Poldermans, L L M Van De Ven, Eric Boersma, Ian R Thomson, Bernard P Paelinck, M G Scheffer, Giuseppe Trocino, Carlo Vigna, Jeroen J Bax, H F Baars
    Abstract:

    Aim To assess the long-term cardioprotective effect of Bisoprolol in a randomized high-risk population after successful major vascular surgery. High-risk patients were defined by the presence of one or more cardiac risk factor(s) and a dobutamine echocardiography test positive for ischaemia. Methods 1351 patients were screened prior to surgery, 846 patients had one or more risk factor(s), and 173 of these patients also had ischaemia during dobutamine echocardiography. One hundred and twelve patients could be randomized for additional Bisoprolol therapy or standard care. Eleven patients died in the peri-operative period (up to 1 month after surgery). Randomized patients continued Bisoprolol or standard care after surgery. During follow-up of 101 survivors (median 22 months, range 11–30) cardiac death or myocardial infarction was noted. No patient was lost during follow-up. Results The incidence of cardiac events during follow-up in the Bisoprolol group was 12% vs 32% in the standard care group ( P =0·025). Cardiac death occurred in 15 patients, nine patients in the standard care and in six in the Bisoprolol group; myocardial infarction occurred in six patients, five in the standard care and one in the Bisoprolol group. The odds ratio for cardiac death or myocardial infarction after surgery in high-risk patients with additional Bisoprolol therapy was 0·30 (0·11–0·83). Conclusions Bisoprolol significantly reduced long-term cardiac death and myocardial infarction in high-risk patients after successful major cardiac vascular surgery.

  • the effect of Bisoprolol on perioperative mortality and myocardial infarction in high risk patients undergoing vascular surgery
    The New England Journal of Medicine, 1999
    Co-Authors: Don Poldermans, L L M Van De Ven, Eric Boersma, Ian R Thomson, Giuseppe Trocino, Carlo Vigna, H F Baars, Jeroen J Bax, J D Blankensteijn, J R T C Roelandt
    Abstract:

    Background Cardiovascular complications are the most important causes of perioperative morbidity and mortality among patients undergoing major vascular surgery. Methods We performed a randomized, multicenter trial to assess the effect of perioperative blockade of beta-adrenergic receptors on the incidence of death from cardiac causes and nonfatal myocardial infarction within 30 days after major vascular surgery in patients at high risk for these events. High-risk patients were identified by the presence of both clinical risk factors and positive results on dobutamine echocardiography. Eligible patients were randomly assigned to receive standard perioperative care or standard care plus perioperative beta-blockade with Bisoprolol. Results A total of 1351 patients were screened, and 846 were found to have one or more cardiac risk factors. Of these 846 patients, 173 had positive results on dobutamine echocardiography. Fifty-nine patients were randomly assigned to receive Bisoprolol, and 53 to receive standard care. Fifty-three patients were excluded from randomization because they were already taking a beta-blocker, and eight were excluded because they had extensive wall-motion abnormalities either at rest or during stress testing. Two patients in the Bisoprolol group died of cardiac causes (3.4 percent), as compared with nine patients in the standard-care group (17 percent, P=0.02). Nonfatal myocardial infarction occurred in nine patients given standard care only (17 percent) and in none of those given standard care plus Bisoprolol (P Conclusions Bisoprolol reduces the perioperative incidence of death from cardiac causes and nonfatal myocardial infarction in high-risk patients who are undergoing major vascular surgery.

  • treatment of the hyperventilation syndrome with Bisoprolol a placebo controlled clinical trial
    Journal of Psychosomatic Research, 1995
    Co-Authors: L L M Van De Ven, B J Mouthaan, M J A J M Hoes
    Abstract:

    The hyperventilation syndrome (HVS) can be regarded as a form of panic disorder associated with a relative increase in sympathomimetic tone, the effects of which can be counterbalanced by beta-adrenoceptor blockade. The efficacy of the beta-blocker Bisoprolol was investigated in a double-blind placebo-controlled randomised crossover trial involving 60 patients from 17 general practices. Following a single-blind placebo prephase, patients who met the inclusion criteria were randomised to treatment with either 5 mg Bisoprolol or an identical-looking placebo tablet once daily for three weeks. They were then crossed over to the other treatment arm. At the end of each treatment phase the number of hyperventilation attacks and the severity of symptoms were assessed and side effects recorded. The number of attacks decreased from 4.04 per week at baseline to 3.52 with placebo and to 1.26 with Bisoprolol. The decrease of attacks with Bisoprolol was significant (p < 0.05) compared to baseline and placebo. The severity of the complaints improved from 29 (scale 0 to 64) at baseline not significantly to 26 with placebo and significantly (p < 0.05) to 15 with Bisoprolol. No serious side effects were reported. Five milligrams of Bisoprolol once daily is effective and safe in the maintenance of symptom reduction in patients with the hyperventilation syndrome.