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2026, Vol: 51, Issue: 2
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Original Research 


Effect of bisoprolol monotherapy and its combination with ranolazine on inflammatory biomarkers and cardiovascular outcomes in patients with chronic coronary syndrome

Muhamad Najmaddin Abdulla, Kawa Fareq Dizaye, Suha Saeed Azeez, Ali H. Shekhani.


Abstract
Objective: To compare the effects of bisoprolol monotherapy versus bisoprolol plus ranolazine on angina severity, functional capacity, and pro-inflammatory cytokines in patients with chronic coronary syndrome, and to evaluate the added value of combination therapy.
Methodology: In this randomized parallel-group study, 60 patients were allocated to either bisoprolol monotherapy (n=30) or bisoprolol plus ranolazine (n=30) for three months. Inclusion criteria were a diagnosis of chronic coronary syndrome. Clinical parameters evaluated were weekly angina attack frequency and walking time, assessed via patient questionnaire. Serum levels of interleukin-1β (IL-1β), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) were measured using ELISA. Group comparisons were performed.
Results: Both groups showed significant improvement (p<0.05) in angina frequency and walking time. However, combination therapy resulted in a significantly greater reduction in weekly angina attacks and a greater improvement in walking time compared to monotherapy (p<0.05). Combination therapy also induced significantly greater reductions in pro-inflammatory cytokines: IL-1β (-52.8% vs. -19.3%), IL-6 (-49.2% vs. -25.1%), and TNF-α (-44.4% vs. -11.5%); all inter-group differences were significant (p<0.05).
Conclusion: Bisoprolol combined with ranolazine provides superior clinical and anti-inflammatory benefits compared to bisoprolol monotherapy in chronic coronary syndrome, supporting its role as an effective adjunct therapy for improved symptom control and systemic inflammation reduction.

Key words: Angina severity, bisoprolol monotherapy, coronary syndrome, combination therapy, pro-inflammatory cytokines.


 
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How to Cite this Article
Pubmed Style

Abdulla MN, Dizaye KF, Azeez SS, Shekhani AH. Effect of bisoprolol monotherapy and its combination with ranolazine on inflammatory biomarkers and cardiovascular outcomes in patients with chronic coronary syndrome. RMJ. 2026; 51(2): 387-391. doi:10.5455/rmj.20260128082154

Web Style

Abdulla MN, Dizaye KF, Azeez SS, Shekhani AH. Effect of bisoprolol monotherapy and its combination with ranolazine on inflammatory biomarkers and cardiovascular outcomes in patients with chronic coronary syndrome. https://www.rmj.org.pk/?mno=308351 [Access: May 27, 2026]. doi:10.5455/rmj.20260128082154

AMA (American Medical Association) Style

Abdulla MN, Dizaye KF, Azeez SS, Shekhani AH. Effect of bisoprolol monotherapy and its combination with ranolazine on inflammatory biomarkers and cardiovascular outcomes in patients with chronic coronary syndrome. RMJ. 2026; 51(2): 387-391. doi:10.5455/rmj.20260128082154


Vancouver/ICMJE Style

Abdulla MN, Dizaye KF, Azeez SS, Shekhani AH. Effect of bisoprolol monotherapy and its combination with ranolazine on inflammatory biomarkers and cardiovascular outcomes in patients with chronic coronary syndrome. RMJ. (2026), [cited May 27, 2026]; 51(2): 387-391. doi:10.5455/rmj.20260128082154


Harvard Style

Abdulla, M. N., Dizaye, . K. F., Azeez, . S. S. & Shekhani, . A. H. (2026) Effect of bisoprolol monotherapy and its combination with ranolazine on inflammatory biomarkers and cardiovascular outcomes in patients with chronic coronary syndrome. RMJ, 51 (2), 387-391. doi:10.5455/rmj.20260128082154


Turabian Style

Abdulla, Muhamad Najmaddin, Kawa Fareq Dizaye, Suha Saeed Azeez, and Ali H. Shekhani. 2026. Effect of bisoprolol monotherapy and its combination with ranolazine on inflammatory biomarkers and cardiovascular outcomes in patients with chronic coronary syndrome. Rawal Medical Journal, 51 (2), 387-391. doi:10.5455/rmj.20260128082154


Chicago Style

Abdulla, Muhamad Najmaddin, Kawa Fareq Dizaye, Suha Saeed Azeez, and Ali H. Shekhani. "Effect of bisoprolol monotherapy and its combination with ranolazine on inflammatory biomarkers and cardiovascular outcomes in patients with chronic coronary syndrome." Rawal Medical Journal 51 (2026), 387-391. doi:10.5455/rmj.20260128082154


MLA (The Modern Language Association) Style

Abdulla, Muhamad Najmaddin, Kawa Fareq Dizaye, Suha Saeed Azeez, and Ali H. Shekhani. "Effect of bisoprolol monotherapy and its combination with ranolazine on inflammatory biomarkers and cardiovascular outcomes in patients with chronic coronary syndrome." Rawal Medical Journal 51.2 (2026), 387-391. Print. doi:10.5455/rmj.20260128082154


APA (American Psychological Association) Style

Abdulla, M. N., Dizaye, . K. F., Azeez, . S. S. & Shekhani, . A. H. (2026) Effect of bisoprolol monotherapy and its combination with ranolazine on inflammatory biomarkers and cardiovascular outcomes in patients with chronic coronary syndrome. Rawal Medical Journal, 51 (2), 387-391. doi:10.5455/rmj.20260128082154


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