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  Bisoprolol in Heart Failure Merck  Merck Recognition of neurohormonalactivation Development Of Neurohormonal Antagonists In Treatment Of CHF 196019701980199020002005 SENIORS 1975; SwedenWaagstein et al.1978  – 80; Swedberg et al. Lancet; Br Heart J CONSENSUS PropranololCaptopril Potential benefit:vasodilatationBB contraindicated:neg. inotropic effects CIBIS IMDCUSCPMERIT-HFCIBIS IICOPERNICUSCOMET CIBIS III SOLVDV-HeFT II AIRE, TRACESAVE, ISIS-4 Landmark Trials  IDN/NONCMCGM/1018/0011 Merck IDN/NONCMCGM/1018/0011 ã  ± 34 % reduction in mortality ã Suggested mechanisms also include reduce remodeling ã β -Blockers may be beneficial through resensitizationof the down-regulated receptor, improving myocardial contractility. ã Acts primarily by inhibiting the sympathetic nervous system. ã Increases beta receptor sensitivity (up regulation). ã Anti-arrhythmic properties. ã Anti-oxidant properties How Well Do -blockers Work In HF ?
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