Low Heart Rate (Bisoprolol) - British Heart Fou...

British Heart Foundation

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Low Heart Rate (Bisoprolol)


It's nagging me now, sometimes I wish I don't have HR monitor. In the morning, after I take my meds (aspirin 75mg, Clopidogrel 75mg and Bisoprolol 2.5mg) my HR goes right down from about 55bpm before tablets to 40-44bpm after tablets.

My BP is normal, right now is 117/64.

It's Bisoprolol that is doing this. Should I speak to my GP to see if they can lower the dose?

34 Replies

You should discuss it with your doctor and/or call the BHF Heart Helpline on 0300 330 3311 (office hours) and talk to a cardiac nurse about it.

HB-HB in reply to jimmyq

Thanks Jimmi, that's a good number to have, I'll stick it in my phone.

I'd discuss it with your Doc. But if it helps, I'm on a similar dosage (+ Ramipril) with a similar resting heart rate and the same happens to me (but with a low of 45bpm and not 40). The Doc doesn't seem to be worried unless I'm light-headed or falling over. But getting this looked at sounds like a good idea.

HB-HB in reply to NorthantsSteve

I will discuss it when I see my GP next time but I won't bother them just for this. If your doctor seems unbothered, can't see mine being either. I'm not falling over nor I'm light headed. It just seems so low but I wouldn't even notice it if I haven't had the monitor. I just get off my chair for a bit and it climbes up to 55.


Hi, what is it that concerns you about your heart rate? Are you having symptoms as a result?

Normal ranges for things like heart rate and BP are a guide only, what’s important is what’s normal for you and any symptoms that you have. My HR is normally in the 40’s to 50’s ( even before being put on beta blockers )

HB-HB in reply to Hidden

Hi. No simptoms, I feel fine. It just seems too low at 38-44bpm in the morning and it made me slightly worried. It's like running out of battery. :D Seriously, it's probably normal, considering BB. I just went for a couple of miles run and cooled down and it's 48bpm. Recently I lost a lot ow weight and got myself very fit, that could be at least some of the reason.

Nathan53 in reply to HB-HB

I think your lower heart rate will be due to both the bisoprolol which is doing what it's meant to do, reducing the pressure on your heart, and also maybe the fact that you are fitter now. Cardiologist informed me that unless you are having adverse symptoms (as described by Tynemouth it's nothing to worry about.

HB-HB in reply to Nathan53

Hi Nathan, thank you. That is exactly what I want to hear and I'm at ease now. I've lost about 15 kilos in last few months and running every day, usually 5K but did 10K on Sunday. I never thought I could do such thing.

Nathan53 in reply to HB-HB

That's amazing HB and shows what you can do with minor adjustments that you stick with - I think your example helps some who sometimes think they can't lose weight etc. I lost 8 kilos in about 6 months which doesnt sound a lot but I was lucky in only needing to loose that to be on target weight. I eat more than before my heart attack but changed to more fish chicken salads and vegetables and cut out snacks in-between meals. After exercise I might have a few almonds or walnuts but no biscuits.

stevejb1810 in reply to HB-HB

Discuss it with your GP by all means but your improvement in you general physical health (exercise and weight loss) will be playing a significant part here. You gave the resting heart rate of a fit athlete 😉

dcbinky2019 in reply to HB-HB

I'm a runner and just been prescribed with bisoprolol for newly diagnosed MVR. I'm actually scarred to take it as my pulse often goes very low. I'm also worried it will affect my running performance. Any advice please

HB-HB in reply to dcbinky2019

I'm taking it since mid September, start of October had 3 stents, started running slowly straight after that. Yesterday I run 5K in 27:56. I run at least 4 times per week, min of 5K. My resting HR goes below 40bpm sometimes. I feel no discomfort or anything. I sugest you take it slowly, get your body to adapt.

dcbinky2019 in reply to HB-HB

Thank you. You have given me reassurance. Your 5k time is excellent.

Best Wishes.

Nathan, what exactly do you mean by "reducing the pressure on your heart"? And why is this beneficial? Surely the whole point of exercise following incidences such as HB-HB's where his heart is undamaged is to get the heart and whole body back to fitness. If people have a damaged heart as a result of HA and it is incapable or dangerous for it to be stressed then I get it, but in cases where the heart is undamaged I don't see why anyone should be on BB's any more than any other normal person. See here


HB made no mention in his post about not having had a heart attack. My explanation was purely to give a basic description of the function of beta blockers. You can still exercise with beta blockers but need to adjust your exercise heart rate. If you need a more in depth explanation maybe contact a BHF Nurse. You make a valid point though

I beg your pardon it was in another very similar thread regarding BB's that I started where he stated he did not have a HA. I would imagine that for a lot of people they are definitely beneficial.

Prada47 in reply to Hidden


In Hospital last week my pulse was low Thirities.

The Cardiac Nurse said something because my Heart was in Tri or Bigeminy the Heart Rate on the recorder was probably reading 30 beats low. I didn't quite understand how that is. Now I am thinking Ectopic Beats are an actual beat just not recorded !! I am on 10mg Bisoprolol daily.

ps Tynemouth is probably my most favourite place in the World.


Alison_L in reply to Prada47

Hi Prada. I'm a namby-pamby southerner from London, with a Geordie husband, and I find Tynemouth far too cold and windy :)

Just cross referenced earlier post for future readers, they may find that post helpful.


HB-HB in reply to mandm65

I know I know, I've asked before. What can I say, got a bit apprehensive again this morning. I should learn to ignore HR monitor really.

I noticed I had a falling heart rate through last year while on 5.0mg Bisoprolol when it went from low 50's down to the low 40's, my GP reduced the dose to 2.5mg and a short while later 1.25mg but my HR only increased to the mid 40's. Following a stay in hospital (unrelated) they got concerned about my low HR so stopped Bisoprolol, currently my resting HR is 47.

I have spoken with my Cardiologist about this and he says its probably due to my improved fitness levels but would like to restart me on a low dose following some AF problems.

I've a similar problem in that my RHR is showing 48/46 bpm even when my dosage of Bisprolol is at the minimum of 1.25mgs per day. I too was concerned. Now after about 9 months of this, I am accepting the rate. I am not dizzy or showing symptoms of any problems.

I had a regular pacing check yesterday for my CRT implanted device and the technician and specialist were happy with the result. Generally they say that, despite my RHR being monitored at 46-49 regularly my normal working speed is actually higher (above 50). They're not concerned and the CRT I have is programmed to cut in at 40bpms.

I think where bisoprolol is concerned it's a question of having your GP agree to you reducing your dose to a minimum and then seeing whether you can cope with that in your day to day living.

Unfortunately our situation is what it is and we have to make the best of it.

According to my doctors even the minimum dosage is better than no pill at all.

I hope that helps. Good luck.

I watch my HR on the console at the gym in the mornings. The rate jumps all over the place for no apparent reason...but I'm still alive.

Take care


Hi HB-HB. I just remember when my husband was diagnosed with blocked heart vessels (needing a quad bypass)! he was put on Bisoprolol 2.5 which slowed his heart rate down to 39-42 bpm. They took the stress of his heart so did the job they were supposed to.

Since coming off these post bypass, his heart rate has returned to the usual 58-62bpm.

See what your GP says if you're worried. Our GP just said "blimey, that slow, do you feel OK?" and then said the "cardiologist must know what he's doing".

All the very best xx

I think you must discuss with your GP, I had similar with Bisopropol and after discussion with the cardiac specialist 5 months post op my daily dose was lowered. Heart rate is now pretty good between 55 to 65 on monitor and BP as near to perfect as possible. I do feel the other issue is that Bisopropol does not help improve breath capacity as so far I only see marginal improvement in walking over pre op condition. Do get best possible expert advice on this and good wishes.

HB-HB in reply to Dockdog

Other than very low HR I don't have any issues or side effects. Maybe a little dizzines if I get up suddenly but I can run like never before. I run every day, 10K last Sunday, 5K on Tuesday, intervals on other days... Today I'll run another 5K, so not all bad.

Dockdog in reply to HB-HB

Hi HB,

Wow I am in awe of your endurance running! I wish I could walk at a reasonable pace for any distance but that is the way the coin falls at 74 with the damage done to my heart through constrictive pericarditis before it was diagnosed and treated. Watch out for the dizzy spells though, a sudden black out can damage

Opposite problem here. Resting heart rate is in the 90s ( after HA). Doc wants to put me back on beta blockers to get it down BUT I'm on BP tablets and a diuretic which are dropping my BP to around 95/55 and feel as if my batteries ran out. The beta blocker would drop it even further.


My HR was dropping into the upper 30s at rest. I was also taking 2.5mg in the morning and 2.5mg at night among others. It wasn't usually a problem but occasionally I would get a dizzy spell if I stood up after being seated for a while. The doc stopped the 2.5mg of the evening and although HR still drops into the 40s at rest dizzy spells have stopped.

As the others have suggested it will be worth a visit to your doctor just to ease your mind

Good luck


HB-HB in reply to Phil-52

It's the same here. Seeing that other people had the same issue and their GPs were not bothered, I don't want to waste my GP's time, I already feel a bit silly for panicking. Thanks and good luck to you too.

My BP in the morning before meds is around 165/120 and HR of anything from 70 to mid 90's.

After meds (including bisoprolol 2.5) will usually level out at around 120/80 and HR mid 60's.

I've just received an appointment for a CT Coronary Angiography with instructions to double my dose of bisoprolol to 5mg for 3 days prior to the CT to slow my HR further.

And they highlighted one line telling me to inform them if I take Sildenafil withing 24 hours . 😯Speechless😯

(Don't laugh if you know what that is) 😱

HB-HB in reply to Griff-64

When I went for my CT scan they asked me if I've take Viagra in the last 24h. :D CT doesn't work properly if you have. But I can thank CT for finding out my blocked arteries and I remember them telling me when I asked how it is; it's not good, they said, but we'll fix you. And they did.


After my heart attack when I was released , about 4 wks later my cardiologist upt my bicoprolol from 1.25 to 2.5 and my bp dropped right down which gave me dizzy spells .

Once I told doc she put me straight back on 1.25 again !

I found bicoprolol gave me breathing issues so I changed to NEBIVOLOL 1.25 which stopped that problem so that worked for me 😋 good luck hope you find a solution regards Adam


I find some of there comments could be very concerning for a large group of those who participate here for it only reflects a percentage of patients. Initially, my thoughts on your post HB-HB was - how on earth can anyone here really comment with any certainty when we don't even have your age! Many learned contributors have advised that everyone is different and if you want a qualified answer, then please go to your GP or cardiac specialist or the BHF as previously stated. You have already been shaken by a genuine reply because you got confused - and that is what can happen. So please do go and get a reply from a professional since it seems so important to you.

Back to my first comment and about percentages. When in hospital before triple heart bypass I was hooked up to a 24/7 monitor and if my BP fell to less than 40bpm, the machine, as with everyone elses machine, began to emit a warning which triggered a response from a nurse to check up on us. It usually went up depending on how pretty the nurse was but I never saw any action or meds being given because of the fall. My resting BP can range from 60 to a max of 80 and the doctor has no concerns, the specialist has no concerns, therefore I have no concerns. However some of the replies here and the low BP's could begin to raise concerns and is the primary reason for my writing - we are all different, all with different health problems, weight, diabetic, other associated illnesses such as asthma etc, so please if anyone is worried, then go to a GP.

Finally, you mention your BP goes up when you get out of a chair - that is normal, quite normal. On the toilet with constipation raises blood pressure, watching a stressful film raises blood pressure as does talking or even reading an exciting book. Thats why the nurse will say before a BP check begins, no talking and completely relax. Last week, I was very stressed at the doctors (many reasons - worry mainly) and my BP was 185 - 2 mins later it was 135 and at home 105. That evening back to normal at 72. It's not so much the figures but the recovery that matters and that you can recover! Most of us can adjust - just by taking a breath and totally relaxing, so please, a raised BP from getting out of a chair is quite normal. I can think of a few reasons for a raised BP, usually at night and that's really normal! Rare but normal

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