Copyright © 2003 by the European Society of Cardiology.
Regular Articles
Bisoprolol dose–response relationship in patients with congestive heart failure: a subgroup analysis in the cardiac insufficiency bisoprolol study (CIBIS II)
a Department of Pharmacology, Saint Antoine University Hospital AP-HP, 27, Rue Chaligny, 75012, Paris, France
b INSERM EMI0214, 56 Bvd V. Auriol, 75013, France
c Department of Pharmacology, Pitié-Salpétrière University Hospital AP-HP, 83, Bcd de l’hopital, 75013, France
* Corresponding author. Tel.: +33-1-40-01-14-57; fax: +33-1-40-01-14-04
E-mail address: tabassome.simon{at}chusa.jussieu.fr
Received 17 August 2002; revised 8 October 2002; accepted 9 October 2002
Aims Whether all patients with congestive heart failure (CHF) need to reach the target dose of beta-blocker to obtain a benefit in terms of survival remains uncertain.
Methods and results We classified by tertile the 2647 patients enrolled in CIBIS II according to the last tolerated dose: low dose (LD: 1.25, 2.5 or 3.75mg/day, 
), moderate dose (MD: 5 or 7.5mg/day, 
) and high dose (HD: 10mg/day, 
) of bisoprolol or placebo (LD=234, MD=278 and HD=808). In both groups, patients tolerating only low doses were significantly older with more severe New York Heart Association (NYHA) functional class and higher frequency of co-morbidities. Treatment withdrawal was associated with a significant increase of mortality in the bisoprolol group (relative hazard (RH)=2.13, 95% confidence interval (CI)=1.43–3.17, 
). After adjustment, all-cause mortality was significantly reduced in the bisoprolol group compared to placebo regardless of the dose level considered: LD (RH=0.66, 95% CI=0.48–0.92), MD (RH=0.33, 95% CI=0.21–0.51) or HD (RH=0.59, 95% CI=0.40–0.89).
Conclusions Bisoprolol reduces mortality in CHF patients at all tolerated dose levels and its withdrawal increases the risk of mortality. Efforts should be made to maintain bisoprolol therapy based on the individual patient's tolerability.
Key Words: Congestive heart failure • Adrenergic beta-antagonists • Dose–response relationship • Mortality
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  C. Funck-Brentano Beta-blockade in CHF: from contraindication to indication Eur. Heart J. Suppl., June 1, 2006; 8(suppl_C): C19 - C27. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Follath Beta-blockade today: the gap between evidence and practice Eur. Heart J. Suppl., June 1, 2006; 8(suppl_C): C28 - C34. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Ponikowski Rationale and design of CIBIS III Eur. Heart J. Suppl., June 1, 2006; 8(suppl_C): C35 - C42. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Willenheimer How to begin treatment in chronic heart failure? Results of CIBIS III Eur. Heart J. Suppl., June 1, 2006; 8(suppl_C): C43 - C50. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Lechat and R. Willenheimer Discussion summary: key clinical questions Eur. Heart J. Suppl., June 1, 2006; 8(suppl_C): C58 - C60. [Full Text] [PDF]
|
|
|
|
 |
|
 M. J. Lenzen, E. Boersma, W. J.M. Scholte op Reimer, A. H.M.M. Balk, M. Komajda, K. Swedberg, F. Follath, M. Jimenez-Navarro, M. L. Simoons, and J. G.F. Cleland Under-utilization of evidence-based drug treatment in patients with heart failure is only partially explained by dissimilarity to patients enrolled in landmark trials: a report from the Euro Heart Survey on Heart Failure Eur. Heart J., December 2, 2005; 26(24): 2706 - 2713. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Metra, C. Torp-Pedersen, K. Swedberg, J. G.F. Cleland, A. Di Lenarda, M. Komajda, W. J. Remme, B. Lutiger, A. Scherhag, M. A. Lukas, et al. Influence of heart rate, blood pressure, and beta-blocker dose on outcome and the differences in outcome between carvedilol and metoprolol tartrate in patients with chronic heart failure: results from the COMET trial Eur. Heart J., November 1, 2005; 26(21): 2259 - 2268. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Willenheimer, D. J. van Veldhuisen, B. Silke, E. Erdmann, F. Follath, H. Krum, P. Ponikowski, A. Skene, L. van de Ven, P. Verkenne, et al. Effect on Survival and Hospitalization of Initiating Treatment for Chronic Heart Failure With Bisoprolol Followed by Enalapril, as Compared With the Opposite Sequence: Results of the Randomized Cardiac Insufficiency Bisoprolol Study (CIBIS) III Circulation, October 18, 2005; 112(16): 2426 - 2435. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Swedberg Conclusions on the management of heart failure Journal of Renin-Angiotensin-Aldosterone System, March 1, 2004; 5(1_suppl): S34 - S36. [Abstract] [PDF]
|
|
|
|
|
|
H. Krum and D. Hare Correspondence Eur. Heart J., February 1, 2004; 25(3): 277 - 277. [Full Text] [PDF]
|
|