The CIBIS III trial: a commentary

Treatment of chronic heart failure (CHF), an important cause of global morbidity and mortality, has evolved in the last three decades.1-3 Activation of neurohormonal systems plays a key role in the pathophysiology and progression of the disease. Therapeutic strategies directed towards their inhibition have reduced morbidity and mortality.3 The major mechanism seems to be related to the inhibition or reversal of remodelling.4 Angiotensin-converting enzyme (ACE) inhibitors are known to reduce symptoms and improve prognosis. The benefit of beta blockers in patients with heart failure has been amply demonstrated by comparing outcomes in patients prescribed a beta blocker or a placebo in patients on optimal treatment with diuretics and ACE inhibitors.