In:
European Journal of Heart Failure, Wiley, Vol. 6, No. 4 ( 2004-06), p. 493-500
Kurzfassung:
Angiotensin‐converting‐enzyme (ACE) inhibitors and β‐blockers are standard therapy for chronic heart failure (CHF). β‐blockers are recommended to be initiated after ACE‐inhibitors, but this order is not evidence based. The initiation order may be important since many, especially elderly CHF patients cannot tolerate target doses of both. Data suggest that β‐blockers may be more important to CHF patients than ACE‐inhibitors, especially in early stages of CHF. Aims: To compare the effect on combined death or hospitalisation of initial monotherapy with either bisoprolol or enalapril, followed by combination therapy. Methods: One‐thousand CHF patients without ACE‐inhibitor, β‐blocker or angiotensin‐receptor‐blocker therapy will be randomised 1:1 to monotherapy with either enalapril or bisoprolol for 6 months, followed by combined therapy for 6–18 months. The primary objective is to show non‐inferiority for bisoprolol‐first vs. enalapril‐first regarding combined death or hospitalisation. If that is shown, superiority for bisoprolol‐first will be tested. Conclusions: If the trial shows non‐inferiority for bisoprolol‐first vs. enalapril‐first, the first CHF therapy may be chosen based on individual judgement in each patient. If bisoprolol‐first is superior to enalapril‐first, a β‐blocker should be given prior to an ACE‐inhibitor in CHF, and the paradigm of testing CHF compounds against a background of ACE‐inhibitor therapy will be challenged.
Materialart:
Online-Ressource
ISSN:
1388-9842
,
1879-0844
DOI:
10.1016/j.ejheart.2003.12.016
Sprache:
Englisch
Verlag:
Wiley
Publikationsdatum:
2004
ZDB Id:
1500332-2
ZDB Id:
1483672-5
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