title: Bisoprolol in the treatment of chronic heart failure: from pathophysiology to clinical pharmacology and trial results.
abstract: Clinical trials have consistently shown the benefits of beta-blocker treatment in patients with chronic heart failure (HF). As a result, bisoprolol, carvedilol, and metoprolol succinate are now indicated for the treatment of all patients with chronic HF who do not have major contraindications. Bisoprolol is the first beta-blocker shown to improve survival in an outcome trial. In the Cardiac Insufficiency Bisoprolol Study II (CIBIS-II), all-cause mortality and sudden death were reduced in patients treated with bisoprolol compared with those on placebo (11.8% vs 17.3%; p < 0.0001 and 3.6% vs 6.3%, p < 0.002; respectively) regardless of age, NYHA functional class, and co-morbidities. Further studies have shown both the efficacy of bisoprolol on secondary endpoints and patients subgroups as well its high cost effectiveness. More recently, CIBIS-III has shown similar efficacy and safety of the initiation of HF treatment with either bisoprolol or enalapril, with a tendency to a survival advantage with bisoprolol. Nowadays, the role of bisoprolol, as well as that of carvedilol and metoprolol succinate, in HF treatment is firmly established and research is mainly focused on implementation of treatment and better dosing. This article will summarize evidence for the efficacy of bisoprolol in the treatment of HF.
authors.affiliation: Section of Cardiovascular Diseases, Department of Experimental and Applied Medicine, University of Brescia Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Metra
authors.forename: Savina
authors.initials: S
authors.lastname: Nodari
authors.forename: Tania
authors.initials: T
authors.lastname: Bordonali
authors.forename: Patrizia
authors.initials: P
authors.lastname: Milani
authors.forename: Carlo
authors.initials: C
authors.lastname: Lombardi
authors.forename: Silvia
authors.initials: S
authors.lastname: Bugatti
authors.forename: Benedetta
authors.initials: B
authors.lastname: Fontanella
authors.forename: Giulia
authors.initials: G
authors.lastname: Verzura
authors.forename: Rossella
authors.initials: R
authors.lastname: Danesi
authors.forename: Livio
authors.initials: L
authors.lastname: Dei Cas