The current role of beta-blockers in chronic heart failure: with special emphasis on the CIBIS III trial
(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)
Please use this url to cite or link to this publication:
https://lup.lub.lu.se/record/1426375
- author
- Willenheimer, Ronnie LU
- organization
- publishing date
- 2009
- 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
- 2016-04-01 13:23:13
- date last changed
- 2022-01-27 18:57:32
@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 < 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}},
keywords = {{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}},
doi = {{10.1093/eurheartj/sup005}},
volume = {{11}},
year = {{2009}},
}