Which β-blocker is preferred in a patient with stable COPD requiring treatment for hypertension and angina, and why?

• A Propranolol — high lipid solubility ensures CNS-independent mechanism
• B Carvedilol — additional α1 blockade provides bronchodilation
• C Sotalol — class III antiarrhythmic activity protects against arrhythmia-triggered bronchospasm
• D Bisoprolol — highest β1 selectivity (β1:β2 selectivity ratio ~120:1) minimizes bronchospasm at standard doses ✓

Explanation

Bisoprolol has the highest β1 selectivity among available β-blockers (β1:β2 ratio approximately 120:1), making it the preferred agent when β-blockade is required in COPD patients. At standard antihypertensive/antianginal doses, β2-mediated bronchoconstriction is minimal. Propranolol is non-selective and contraindicated in obstructive lung disease. Carvedilol's α1-blockade does not provide net bronchodilation; the β2 blockade still risks bronchoconstriction. All β-blockers should still be used with caution in severe/unstable COPD.

Reference: KD Tripathi, Essentials of Medical Pharmacology, 8th ed.

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