Revisiting Pharmacotherapy in Nonobstructive Hypertrophic Cardiomyopathy: Insights from a Randomized Triple-Crossover Trial of Bisoprolol vs. Verapamil

Bisoprolol significantly reduced peak oxygen consumption (pVO2) compared to both placebo and verapamil in patients with nonobstructive hypertrophic cardiomyopathy (HCM).
Verapamil treatment resulted in improved global longitudinal strain (GLS) and a significant reduction in N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels.
Contrary to traditional practice, bisoprolol was associated with a decrease in health-related quality of life scores and an increase in left atrial volume index (LAVI).
These findings challenge the routine use of beta-blockers as first-line therapy for the nonobstructive phenotype of HCM, suggesting a more favorable physiologic profile for calcium-channel blockers.