Reevaluating Beta Blockers: New Evidence in Non-Obstructive HCM Care

Dr. Florian Rader joins Dr. Louise Bjerregaard to discuss a groundbreaking randomized, double-blind, triple-crossover trial that challenges the long-standing "mantra" of using beta blockers as first-line therapy for non-obstructive hypertrophic cardiomyopathy (HCM). Dr. Bjerregaard explains how the study compared bisoprolol, verapamil, and placebo, revealing that bisoprolol actually resulted in a significant reduction in functional capacity and a worsening of patient symptoms as measured by the KCCQ score. The conversation explores why slowing the heart rate may be detrimental to patients with "stiff hearts" who rely on chronotropic competence to maintain cardiac output, and why calcium channel blockers like verapamil might be a more favorable alternative for symptom management. This episode is essential listening for clinicians looking to move beyond expert opinion toward evidence-based, personalized care for their non-obstructive HCM patients.View the results of the trial here: https://www.jacc.org/doi/10.1016/j.jacc.2025.11.028