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The current role of beta-blockers in chronic heart failure: with special emphasis on the CIBIS III trial

Willenheimer, Ronnie LU (2009) In European Heart Journal Supplements 11(A). p.15-20
Abstract
Beta-blockers (bisoprolol, metoprolol succinate, carvedilol, and to some extent nebivolol), given on top of angiotensin-converting enzyme (ACE) inhibitors, improve survival and reduce morbidity in symptomatic stable chronic heart failure (CHF). Early beta-blockade may help to improve survival and especially prevent sudden death, but the usual practice of starting the ACE inhibitor first may lead to undertreatment with beta-blockers. The Cardiac Insufficiency Bisoprolol (CIBIS) III trial examined the optimum order of initiating CHF treatment in 1010 patients ( :65 years), with stable, mildly, or moderately symptomatic, systolic CHF. Patients were randomized to initial monotherapy with bisoprolol for up to 6 months, followed by the addition... (More)
Beta-blockers (bisoprolol, metoprolol succinate, carvedilol, and to some extent nebivolol), given on top of angiotensin-converting enzyme (ACE) inhibitors, improve survival and reduce morbidity in symptomatic stable chronic heart failure (CHF). Early beta-blockade may help to improve survival and especially prevent sudden death, but the usual practice of starting the ACE inhibitor first may lead to undertreatment with beta-blockers. The Cardiac Insufficiency Bisoprolol (CIBIS) III trial examined the optimum order of initiating CHF treatment in 1010 patients ( :65 years), with stable, mildly, or moderately symptomatic, systolic CHF. Patients were randomized to initial monotherapy with bisoprolol for up to 6 months, followed by the addition of enalapril, or the opposite sequence. Mean follow-up was 1.2 years. The bisoprolol-first and enalapril-first strategies showed similar efficacy for the combined primary endpoint of mortality or all-cause hospitalization, and similar safety. Compared with the enalapril-first strategy, the bisoprolol-first strategy significantly reduced sudden death during the first year on treatment by 46% (P < 0.05). Patients who achieved higher doses of the study drugs (particularly bisoprolol) had substantially and independently lower mortality and hospitalization risks. Thus, CIBIS III supports a free choice between bisoprolol and enalapril as initial therapy for stable, mild-to-moderate, systolic CHF, and suggests that early beta-blockade reduces the risk of sudden death in the first year. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
enzyme inhibitor, Sequence of drug initiation, Angiotensin-converting, Beta-blocker, Chronic heart failure, Therapy
in
European Heart Journal Supplements
volume
11
issue
A
pages
15 - 20
publisher
Oxford University Press
external identifiers
  • wos:000265835900004
  • scopus:77949412828
ISSN
1520-765X
DOI
10.1093/eurheartj/sup005
language
English
LU publication?
yes
id
fc9858a3-cb51-4661-9e5a-6bcafc3ea94e (old id 1426375)
date added to LUP
2009-06-29 15:52:16
date last changed
2017-01-01 05:38:33
@article{fc9858a3-cb51-4661-9e5a-6bcafc3ea94e,
  abstract     = {Beta-blockers (bisoprolol, metoprolol succinate, carvedilol, and to some extent nebivolol), given on top of angiotensin-converting enzyme (ACE) inhibitors, improve survival and reduce morbidity in symptomatic stable chronic heart failure (CHF). Early beta-blockade may help to improve survival and especially prevent sudden death, but the usual practice of starting the ACE inhibitor first may lead to undertreatment with beta-blockers. The Cardiac Insufficiency Bisoprolol (CIBIS) III trial examined the optimum order of initiating CHF treatment in 1010 patients ( :65 years), with stable, mildly, or moderately symptomatic, systolic CHF. Patients were randomized to initial monotherapy with bisoprolol for up to 6 months, followed by the addition of enalapril, or the opposite sequence. Mean follow-up was 1.2 years. The bisoprolol-first and enalapril-first strategies showed similar efficacy for the combined primary endpoint of mortality or all-cause hospitalization, and similar safety. Compared with the enalapril-first strategy, the bisoprolol-first strategy significantly reduced sudden death during the first year on treatment by 46% (P &lt; 0.05). Patients who achieved higher doses of the study drugs (particularly bisoprolol) had substantially and independently lower mortality and hospitalization risks. Thus, CIBIS III supports a free choice between bisoprolol and enalapril as initial therapy for stable, mild-to-moderate, systolic CHF, and suggests that early beta-blockade reduces the risk of sudden death in the first year.},
  author       = {Willenheimer, Ronnie},
  issn         = {1520-765X},
  keyword      = {enzyme inhibitor,Sequence of drug initiation,Angiotensin-converting,Beta-blocker,Chronic heart failure,Therapy},
  language     = {eng},
  number       = {A},
  pages        = {15--20},
  publisher    = {Oxford University Press},
  series       = {European Heart Journal Supplements},
  title        = {The current role of beta-blockers in chronic heart failure: with special emphasis on the CIBIS III trial},
  url          = {http://dx.doi.org/10.1093/eurheartj/sup005},
  volume       = {11},
  year         = {2009},
}