Beta-blockade treatment in heart failure: the cardiac insufficiency bisoprolol study (CIBIS) project. CIBIS Committees and Investigators. Cardiac Insufficiency Bisoprolol Study.
The efficacy of treatment with diuretics and vasodilators in heart failure has shown that compensatory mechanisms may induce vicious circles that can precipitate the deterioration of congestive heart failure (CHF). By counteracting sympathetic stimulation of cardiac beta-receptors, beta-blocking drugs could provide some benefit in CHF. Indeed, the sympathetic stimulation enhances metabolic costs and could lead to a further deterioration of myocardial fiber function. This could be counteracted by beta-blockade. On the contrary, the loss of adrenergic responsiveness due to beta-adrenergic downregulation and depletion of norepinephrine stores from sympathetic nerves could be responsible for the progressive deterioration of cardiac function. Moderate doses of beta-blocking agents could restore such a catecholamine sensitivity by upregulation of beta-receptors and restoration of norepinephrine stores. Results of clinical trials with beta-blockade in CHF are so far controversial. Most studies enrolled patients with cardiomyopathy and included small numbers of patients or were uncontrolled. The CIBIS trial (Cardiac Insufficiency Bisoprolol Study) has been launched in Europe to answer the question of the potential benefit on prognosis of beta-blockade therapy in heart failure from any etiology, especially ischemic CHF. It is a randomized, placebo-controlled, double-blind multicentric trial involving two parallel groups of patients (300 in each group) followed over a 2-year period. Results from the CIBIS trial should provide conclusive information concerning the use of beta-blocking therapy in CHF.
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Département de Pharmacologie Clinique, Hôpital Pitié Salpétrière, Paris, France.
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D017298:Bisoprolol / Q000627:therapeutic use*; D002316:Cardiotonic Agents / Q000627:therapeutic use; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D015337:Multicenter Studies as Topic / Q000379:methods*; D016032:Randomized Controlled Trials as Topic / Q000379:methods
D000319:Adrenergic beta-Antagonists; D002316:Cardiotonic Agents; D017298:Bisoprolol