Benefits of starting CHF treatment with beta-blocker

September 05, 2005

Initiating treatment with the selective beta-blocker, bisoprolol, is as effective and well tolerated as beginning treatment with an ACE inhibitor. However, starting treatment with bisoprolol may reduce the risk of death especially in the first year of treatment.

These findings from the Cardiac Insufficiency BIsoprolol Study III (CIBIS III) challenge the current assumption that treatment of heart failure should begin with an ACE inhibitor subsequently followed by a beta-blocker.

CIBIS III is the first large prospective study to compare the two drug initiation strategies. In newly diagnosed patients over age 65 years (mean age 72 years) treatment was either begun with bisoprolol (n=505 ) or enalapril (n=505). Subsequently, all patients received combination treatment of the two agents. Treatments were titrated to usually recommended doses.

By the end of the study there were no significant differences in either the efficacy or tolerability of the two treatment arms. As a result, one of the principal investigators, Professor Ronnie Willenheimer, Director of Research Unit in the Department of Cardiology at the University Hospital Malmö, Sweden said: "CIBIS III challenges the view that treatment of heart failure patients should be started with an ACE inhibitor rather than a beta-blocker. CIBIS III questions the logic behind such a recommendation."

Evaluating patients after the first year of treatment in a post-hoc analysis, CIBIS III suggests there was a benefit in starting patients on bisoprolol rather than enalapril. In the initial year of treatment, 42 patients in the bisoprolol-first group had died versus 60 deaths in the enalapril-first group; a difference of 31% (p=0.065).

Implications of CIBIS III
Professor Willenheimer said: "Current treatment guidelines recommend that patients with heart failure should begin with an ACE inhibitor, to which a beta-blocker should be added. This strategy has never been tested before in a large, well conducted comparative prospective trial.

"CIBIS III shows that starting treatment with bisoprolol is at least as effective and well tolerated as an ACE inhibitor-first strategy in a population which is typically seen in daily practice (mean age 72 years) over >2 years.

"However, the bisoprolol-first strategy may offer important advantages in the first year of treatment when the risk of sudden cardiac death is particularly high. At this time bisoprolol's pronounced inhibition of the sympathetic system (not seen with an ACE inhibitor) may be of particular value at this critical timepoint when the risk of sudden death is greatest."

Earlier studies show that the first drug initiated in heart failure patients is most likely to be titrated to the full effective dose. Conversely, the second drug may never be fully up-titrated or indeed, never initiated at all.

"We now know from CIBIS III that bisoprolol can be started first as safely as an ACE inhibitor in heart failure patients. And for some, it may have additional benefits that should be considered," Professor Willenheimer concluded.

European Society of Cardiology

Related Heart Failure Articles from Brightsurf:

Top Science Tip Sheet on heart failure, heart muscle cells, heart attack and atrial fibrillation results
Newly discovered pathway may have potential for treating heart failure - New research model helps predict heart muscle cells' impact on heart function after injury - New mass spectrometry approach generates libraries of glycans in human heart tissue - Understanding heart damage after heart attack and treatment may provide clues for prevention - Understanding atrial fibrillation's effects on heart cells may help find treatments - New research may lead to therapy for heart failure caused by ICI cancer medication

Machining the heart: New predictor for helping to beat chronic heart failure
Researchers from Kanazawa University have used machine learning to predict which classes of chronic heart failure patients are most likely to experience heart failure death, and which are most likely to develop an arrhythmic death or sudden cardiac death.

Heart attacks, heart failure, stroke: COVID-19's dangerous cardiovascular complications
A new guide from emergency medicine doctors details the potentially deadly cardiovascular complications COVID-19 can cause.

Autoimmunity-associated heart dilation tied to heart-failure risk in type 1 diabetes
In people with type 1 diabetes without known cardiovascular disease, the presence of autoantibodies against heart muscle proteins was associated with cardiac magnetic resonance (CMR) imaging evidence of increased volume of the left ventricle (the heart's main pumping chamber), increased muscle mass, and reduced pumping function (ejection fraction), features that are associated with higher risk of failure in the general population

Transcendental Meditation prevents abnormal enlargement of the heart, reduces chronic heart failure
A randomized controlled study recently published in the Hypertension issue of Ethnicity & Disease found the Transcendental Meditation (TM) technique helps prevent abnormal enlargement of the heart compared to health education (HE) controls.

Beta blocker use identified as hospitalization risk factor in 'stiff heart' heart failure
A new study links the use of beta-blockers to heart failure hospitalizations among those with the common 'stiff heart' heart failure subtype.

Type 2 diabetes may affect heart structure and increase complications and death among heart failure patients of Asian ethnicity
The combination of heart failure and Type 2 diabetes can lead to structural changes in the heart, poorer quality of life and increased risk of death, according to a multi-country study in Asia.

Preventive drug therapy may increase right-sided heart failure risk in patients who receive heart devices
Patients treated preemptively with drugs to reduce the risk of right-sided heart failure after heart device implantation may experience the opposite effect and develop heart failure and post-operative bleeding more often than patients not receiving the drugs.

How the enzyme lipoxygenase drives heart failure after heart attacks
Heart failure after a heart attack is a global epidemic leading to heart failure pathology.

Novel heart pump shows superior outcomes in advanced heart failure
Severely ill patients with advanced heart failure who received a novel heart pump -- the HeartMate 3 left ventricular assist device (LVAD) -- suffered significantly fewer strokes, pump-related blood clots and bleeding episodes after two years, compared with similar patients who received an older, more established pump, according to research presented at the American College of Cardiology's 68th Annual Scientific Session.

Read More: Heart Failure News and Heart Failure Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to