Bisoprolol: I have always had a low resting... - AF Association

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Kayjas profile image

I have always had a low resting heart rate of about 46 bpm.

My doctor has prescribed me 2.5mg of bisoprolol. Should I be concerned that this will slow my resting heart rate to a dangerous level?

The tablet is dealing with heart flutters.


51 Replies

Hi, Kayjas

When I was a young athlete, a heart rate of 30 bpm was fine.

When I was old, and had AF, a sleeping heart rate of 30 bpm made me wake up paralysed from the eyelids down.

I do not know about the effects of bisoprolol:

Have you started it yet?

Do you feel faint? e.g. when you stand up?

I now have a pacemaker, which keeps my heart rate at 60 or above.

Kayjas profile image
Kayjas in reply to S11m

Until I can talk to my doctor I have cut the tablet in half and this has reduced my blood pressure to "normal" and reduced my resting heart rate to 46bpm from 53bpm. Apart from initial headache I feel fine.

Years ago I did a lot of long distance cycling but absolutely not an athlete.

S11m profile image
S11m in reply to Kayjas

When I was cross-country running for my school, I did not think of myself as an athlete - nor when I cycled 760 miles in 90 hours - but, perhaps, I was?

S11m profile image
S11m in reply to Kayjas


Nerja2012 profile image
Nerja2012 in reply to S11m

SIlm . I have a low heart rate and low Diastolic both in the 50s. I refused 2.5 because of it so agreed to 1.25 which I find is still too low. Now taking half of the 1 .25 on alternate days. I think the feeling is if your not having Dizzy spells and feeling faint its ok. But I still am so needs some answers. I had an ecg and the doc said my heart rate was fine. It would be because I have white coat syndrome so I will take my own BP machine with me when I see Cardiolagist soon , then he can see what my actual readings are as its on memory. Good luck with it.

Spinners profile image
Spinners in reply to Nerja2012

I too have white coat syndrome. It is so bad that my BP and pulse sometimes soar to dangerous levels when seeing the cardiologist, high at the doctors and within acceptable range at home. I take my home BP monitor with me every time I go to the surgery for a BP check and have a reading from both. Then they accept my home BP measurements, even if it is high at the surgery. Such a relief to be treated for day to day BP, not the surges I get when officially monitored.

Nerja2012 profile image
Nerja2012 in reply to Spinners

Spinners. It was my GP who suggested it. Good idea.

sdonate profile image
sdonate in reply to Nerja2012

Spinners ....

DERLIN profile image
DERLIN in reply to Spinners

What is white coat syndrome?

Spinners profile image
Spinners in reply to DERLIN

It is when your heart rate and blood pressure soar involuntarily in the presence of doctors etc. It refers to the white coats doctors and medical staff always used to wear.

I’m not medically trained Kayjas but given your heart rate is below normal range then it seems quite likely that the Bisoprolol will lower it further. Are we talking GP or Specialist doctor because if it’s the former then I think you should seek specialist advice. Also, it is normal to start on the lowest dose (1.25 mg) and then increase as necessary but it will be interesting to hear what others say......

Kayjas profile image
Kayjas in reply to FlapJack

It is a GP after a referral letter from a cardiologist at local hospital. I was fitted with a monitor to wear for 2 days.Being that I have a slow HR I am surprised that they have prescribed a BB

Hi Kay.

I'm not a medic and can't second guess your doctor. Bisoprolol will slow your HR though - that's one of the reasons it's used. If it were me I would check my rate and if it drops to low contact your GP for advice. It comes in different strengths eg 1.25 / 2.5 / 3.75 / 5 mg. When I had problems with it my GP reduced the dose. However we are all different and that would be a matter for your doc to decide.

Keep your eye on it though and I'm sure you'll be fine.


Kayjas profile image
Kayjas in reply to Paulbounce

What is considered too low?

Paulbounce profile image
Paulbounce in reply to Kayjas

I don't think there's a hard and fast rule - as above we are all different. Normal is considered between 60 - 100 bpm. However for me personally around 55 bpm at rest is ideal. I dropped to 46 bpm some months ago when I was in sinus and felt great. However if I went much lower (IMO) I would have had it checked.

Maybe this link will explain more.


LaceyLady profile image
LaceyLady in reply to Kayjas

It depends on how you feel on it.

I having problems with it too, reduced to 1.25 was ok for a while, HR was 60’s, but now gone back to low 50’s mainly at night.

BobD profile image
BobDVolunteer in reply to Kayjas

Normal heart rate is between 60 and 100. Below 60 is bradycardia and above 100 tachycardia. It is a very individual thing and no two people feel the same.

I once tested an 80 year old ex lifeboat coxwain with a HR of 30 who was perfectly healthy and happy. I freaked out when I saw the reading. He raored with laughter. lol 😁

Kayjas profile image
Kayjas in reply to BobD

So worst case scenario the 2.5mg tablet won't slow my heart rate to a speed where it could be dangerous.I'm now thinking I was overthinking this 😃

john6 profile image
john6 in reply to Kayjas

Yes it can drop your HR to a dangerous level, imo you are not overthinking it. Mine was dropping into the 30s when asleep thus kicking my Afib off big time practically every night. As you already have a low HR I do not see the sense in lowering it even more, if it is for BP then I'm sure that there are other medications that can do the job without potentially bringing other problems in.

My thoughts are that if you start getting woken up with Afib, then I feel that it is fair to say that your HR is telling you that it is going too low.

CDreamer profile image
CDreamer in reply to Kayjas

Yes it could but rather than look purely at numbers - listen to your body. Everyone reacts very differently & what maybe ok fo some may not be for others.

Eg: my systolic BP is rarely more than 105 & I feel great. BobD is symptomatic at 110.

Anything lower than 45 in older age I think will be of concern, certainly was for my EP but then my normal resting was always +60 until I got AF, then it could plummet at night & give me nocturnal AF.

KMRobbo profile image
KMRobbo in reply to Kayjas

I do not believe you are overthinking it. my normal HR was 68 -70 when I first got AFIB 1.25 bisop dropped me to 45 (from memory) and I was asleep 40 mins after taking it!. I only took it for 8 days as it was clear the cure was worse that the Afib (1 occurence), My GP was concerned I would drop well into the 30s when asleep, which she eas not happy about at all . After trying Atenolol another BB with better but still bab results she decided I did not get on with BBs, and moved to calcium channel blockers instead.

My doctor gets totally freaked out when I tell her my HR is often in the early 40's on most of the meds I have been on ( about 5 different ones ) but my cardiologist never gets concerned as he just says that is what the meds are for to get a regular rate even if it is on the low side. I did however email him when changed from flecainide to bisoprolol as when 2.5 was making me lightheaded when dipping to 41/42 so he changed the dose to 1.25mg and that pushed it up to 47/48 so we were all happy. I am now on dronedarone having struggled with my eyes whilst on amiodarone , but even now in the mornings I can get down to 44 bpm but feel ok and 100 times better than when in AF, I have had two ablations. I take my BP morning , lunchtime and an hour after my evening meal and it is consistently good and as requested I feed the averages through about every three months or if I have a concern.

I have always had a low hr. Resting hr is about 45. I developed svt and was put on 1.25 of Bisoprolol. On reading the leaflet it said don’t take it if your hr is below about 60. I was worried. I spoke to the chemist, then my GP. The GP said the cardiologist recommended it. I spoke to the cardiology team and they said if I feel ok, not fainting or anything I should be ok. It generally stopped my hr going over about 100.Also, I have an implant loop recorder. It is set so that if my hr goes below 30 or over 170 it records it and sends the recording to the cardiologist. I think it dropped below 30 once in my sleep.

I had an ablation about a year ago. No svt, no meds. All good. Resting hr about 45.

My hr is very low usually 45-55, I was on bisolprolol for 8 years or so and felt ok but in the last 2 years my new GP has taken me off them completely ,my hr hasn't altered that much actually and I feel fine .

I can only speak from personal experience on this I usually have a resting heart rate of around 55 .When diagnosed with PAF 4 years ago I was immediately put on a dose of Bisprolol 1.25 mg daily. I was constantly tired, lacking energy and my HR dropped to mid 40's .I agreed with my EP to only use Bisoprolol during an episode of AF which thankfully only comes on once every few months which works for me .

I'm sure like all things your reaction to a drug will be individual and as some will say it can take time for the body to adjust to it but I certainly feel much more comfortable using Bisoprolol as a pill in the pocket rather than a daily preventative.

I am 77........ 40 years of various arrhythmias incl a decade with Afib. 2 ablations. RHR 52 to 53 bpm. Can be 45 in wee hours. On low dose Amiodarone and Apixaban. BP 130 / 73 this morning. Just wonder what your doctors medical motive was when considering his prescription. Take care.

My EP stopped my Bisoprolol because I developed conductivity disease. My heart rate is always between 40 & 50bpm when resting and always below 45 on waking.


Hi kayjas my ep put me on bisoprolol 1.25 mg and told me they wanted my heart rate to be around 60 bmp and said certainly no lower than 55bpm but everyone i guess is different my gp put me on 5mg first which literally wiped me out

My recommendation is to trust your doctors since they know exactly what they are doing and why they are doing it. The treatment of an individual's heart condition is often affected by confounding factors which could mean that the cardiologist is limited in what he or she can do. If I were you, I would phone your consultant via their hospital secretary, or, failing that, the arrythmia clinic or your GP.

That said, unless you were told differently, there's nothing to be lost by starting on the lowest dose and building this up as the effects are known. But - again - this is for your doctor to decide. Bisoprolol does not have a linear dose response either, so halving the tablet does not halve the effect and 1.25mg is still a potent dose.


Both me and my wife takes it. It as solved the problems with palpitations. But as given me raving insomnia. My Doctor as said that I would be advised to keep taking it owing to my heart conditions.

john6 profile image
john6 in reply to ATSF

What time of the day are you taking it?

ATSF profile image
ATSF in reply to john6

We have both been advised to stop taking it at breakfast time and take it around midday with or after food.

john6 profile image
john6 in reply to ATSF

Ok, I was thinking that the earlier in the day that you were taking it, then the potency might be less going to bed, thus a calmer rest.

The other thing that many tend to do, is to think that it is their medication causing a problem! Have you considered that it may very well be foods or drink that you may be consuming during the day/evening? I'm thinking that they could very well be giving you energy that has nowhere to go which will stop you sleeping. Occasionally it is the most innocuous of foods/drinks that can cause sleepless nights which then become a disruptive pattern.

ATSF profile image
ATSF in reply to john6

We are both tired in the mornings, do not consume much alcohol and very rarely eat anything in the evenings. The reason for the take it later in the day was that my blood pressure is very low most mornings, while,my wife was advised to separate it from one of her other MDs.

My resting heart rate was around 55bpm when prescribed with bisoprolol and it took my blood pressure and heart rate so low I could hardly function feeling sick , dizzy and weak.I no longer take it daily and just have pill in pocket when needed and feel so much better!

Everyone reacts differently though so until you try you don’t really know.

Luckily I stopped after 8 days as I’ve heard it’s difficult just to stop suddenly if you have been taking it for a while.

Hi. I am on 1.25mg per day and recently am experiencing pins and needles/ numbness in both arms when in bed. As for you my heart rate when sleeping has decreased.Any similar issues?

HiMy heart rate is 55/57 when resting, I’m on 10mg of bisoprolol I spoke to gp & because I’m paf & have been having more episodes than usual she also said I can go up to 20mg if needed.

john6 profile image
john6 in reply to Jgc61

Rather than increase the Bisoprolol dosage then perhaps your GP should be considering alternative medication. After 5 years of numerous daily episodes, my medication was changed ( and what a difference). In fairness it is still never far away as exertion will set it off ie lifting heavy stuff or walking up hills, however, normal everyday day living and I am getting by without much trouble.

I note that you mention GP! It would imo be better for you to speak to someone with more in depth knowledge.

Jgc61 profile image
Jgc61 in reply to john6

Originally it was my cardiologist who put me on bisoprolol, started in a low dose then he increased me to 5mg, my gp got in touch with him as I’d been admitted then it went up to 7.5mg + Apixaban.My gp upped it to 10mg. Not happy with either of them at mo, they seem to like playing piggy in the middle with me in the middle. Come tomorrow I’ll be on the phone for a face to face appointment

Hi KayjasI can understand your concerns. When I was a runner, even though it was only for short distances, and when I was in my 40’s, my BP and my heart rate were low. Way back then it was usually in the 40-45 bpm range. Unbeknown to me that was when my Afib journey began but the events were so rare that I didn’t make the connection.

Skip forward a couple of decades and I was no longer running but my bpm was still low, in the 50’s but my Afib accelerated until they took me seriously and I ended up several times being admitted to the cardiac wards. I was routinely given bisoprolol on the wards but they had to routinely switch off the alarm on the ECG because I was continuously dropping below 45 bpm and the noise was irritating the nursing staff! ! The alarm is set to sound when the bp drops too low.

So long story short, why are they giving you a drug which will knowingly drop your heat rate to what is considered to be dangerously low?


Kayjas profile image
Kayjas in reply to Maggimunro

Thanks for reply. What seems odd to me is that I received a copy of a letter that was sent to my GP from the cardiologist and it basically said no concern s. Then my GP phoned me and read out the letter from a different cardiologist that wants me to take the bisoprolol. I said it was a different letter and questioned if it had my name on it. The GP ignored my comment and prescribed the drug over the phone.

cassie46 profile image
cassie46 in reply to Kayjas

That seems very odd. Have you seen two different cardiologists recently. I would ask the surgery for a copy of the other letter for your own files. Your GP does not sound good, very rude not to answer your valid query. Also you should contact the cardiologist or his secretary to query the two letters.

Kayjas profile image
Kayjas in reply to cassie46

Thanks for reply. All I have done is worn a heart monitor for 24 hours and returned it to the hospital. I have not actually seen a cardiologist.

Maggimunro profile image
Maggimunro in reply to Kayjas

Odd indeed. Question it.

Hi Bisoprolol 1.25 took my heart rate fell to 40 during the night and o ly 50ish during the day so walking a flat pavement was leaving me breathless.

Hi.I am on 2.5mg of Bisoporol and have a low resting heartbeat of around 42/43 which can during the night drop to 38.

I don't think the 2.5mg Bisoporol, which is considered to be a low dose, reduces my resting heartbeat significantly and as it was my Cardiologist who prescribed the medication I'm not concerned.

Of course you should speak to your doctor if you are concerned.

Hi fellow slow beater,I was worried when put on Bisoprolol just over a year ago as my pulse is under 50 resting, but a year of living with it has proven there is nothing I should be worried about. I have episodes of 6-9 hrs of AFib ever two weeks (on the dot) otherwise I’m right as rain.

Bisoprolol is a lifestyle slower which I hate but I’m relaxed about the effects of the Bisoprolol in relation to slowing my pulse. It’s just me.

Good luck 🤞

Hi,Bit of a long read but here's my Bisoprolol story....

I am on a reducing dose of Bisoprolol, used to apply a brake to my heart rate when in AF.

A year ago, I was on 7.5mg per day. An excessive amount as even when exercising my HR never exceeded 54bpm so my heart didn't pump enough blood to the relevant muscles, brain and lungs.

I thought that it was the price of survival whilst waiting for an ablation and then the pandemic started.

I got to thinking about Bisoprolol and the "brake" that I had convinced myself (along with the previously mentioned side affects plus my lack of energy and general apathy!) and due to the serious restrictions on seeing my Doctor, I decided to take matters into my hands.

I started taking detail measurements of my BP and HR since AF diagnosis so I made a proposal to the Doc which meant him seeing my numbers and agreeing to a gradual reduction of Bisoprolol to at least get my HR up a bit so my energy levels improved.

Long story, but with constant HR and BP measurements, I was able to track the changes as the medication reduced so that the adjustments could be reversed. Right now, I'm on 1.25 once per day with a view to stopping Bisoprolol completely and my energy has returned with a much more "normal" heart range having sacrificed a lower BP for a slightly elevated systolic measurement.

So, my advice is to recognise that you are taking a powerful medication at I believe, the minimum dose If you don't already, monitor your HR and BP on a spreadsheet to give your Doc something to work with and to give you some control over your situation.

Hope this helps.


I'm wondering why your doctor didn't prescribe an anti-arrhythmia drug instead of one for rate control. I'm no expert; just wondering. Can you perhaps questions your doctor?

My resting heart rate is always below 50 bpm, I am on 2.5mg Bisoprolol , basically who knows, I am generally ok but am also concerned about Bisoprolol on already low heart rate, it is a concern, without Bisoprolol maybe my Afib would be worse.

I was on 2.5mg Bisoprolol originally but, after feeling light headed, feeling tingling in my extremities and quite low BP, I asked to have the dose halved to 1.25mg and I am now fine with this. Just make sure that you monitor things and get the dose adjusted is my advice.

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