In that trial, sudden deaths were reduced by 44% in the bisoprolol-treated group, whereas pump failure deaths were reduced by 26%.170 Nebivolol is a 1 -selective -blocker with vasodilating properties related to nitric oxide modulation. In the Study of the Effects of Nebivolol Intervention on Outcomes and Rehospitalization in Seniors with heart failure (SENIORS) of 2128 patients 70 years of age with a history of HF, nebivolol Rosendorff et al Treatment of Hypertension in Patients With CAD 1395 significantly decreased all-cause mortality or cardiovascular hospital admissions over a 21-month follow-up.268 Although all 4 of these agents (metoprolol succinate, carvedilol, bisoprolol, and nebivolol) are beneficial in patients with HF, the Carvedilol or Metoprolol European Trial (COMET) demonstrated a 17% greater mortality reduction in favor of carvedilol compared with metoprolol tartrate (not the formulation used in MERIT-HF, which was metoprolol suc- with mean daily doses of 42 and 85 mg/d, respec- Carvedilol may be particularly appealing because of its additional -blocking properties. There also may be a more favorable effect on glycemic control. As a result of these studies, -blockers are recommended for the long-term management of patients with hypertension- related LV systolic dysfunction. Patients should preferably receive 1 of the 4 -blockers proven to reduce mortality (carvedilol, metoprolol succinate, bisoprolol, or nebivolol). 6.7.5. Nitrates and Hydralazine Nitrate tolerance has limited the ability of long-term nitrates alone to be effective as antihypertensive agents. The addition of hydralazine to a nitrate reduces this tolerance. The African- American Heart Failure Trial (A-heFT)270 showed that a com- bination of a fixed dose of isosorbide dinitrate and hydralazine provides additional benefit in African American patients with advanced HF. 