[Significance of the BRING-UP studies]

BRING-UP, as already known, is an observational study of outcome of the use of beta-blocker therapy for heart failure. This has been an extraordinary event in clinical medicine: a class of drugs, the beta-blockers, which clinical evidence transformed from being considered as contraindicated into being recommended. This exceptional situation, together with the growing awareness of the limited spread and applicability of evidence produced by trials into clinical practice led to undertaking observational studies to evaluate the feasibility, safety and practical results of the implementation of new therapies recommended for widespread use on the basis of results of controlled, randomized clinical trials. BRING-UP 1 will be followed by BRING-UP 2, the aim of this latter being to assess the effects of beta-blocker therapy on populations underrepresented in randomized trials, and SET-UP, on the use of GP IIb/IIIa platelet receptor inhibitors in unstable angina. BRING-UP has started a new line of research which does not substitute randomized trials, but complements and completes them. For this type of study to become common practice in clinical research, there must be greater interaction and acceptance by pharmaceutical companies and national and international regulatory bodies and a widespread conviction among doctors that this research has a paramount scientific, clinical and social value.