Achieving a Maximally Tolerated β-Blocker Dose in Heart Failure Patients: Is There Room for Improvement?

Journal of the American College of Cardiology
Ankeet S BhattRobert J Mentz

Abstract

Heart failure (HF) is associated with significant morbidity and mortality. Although initially thought to be harmful in HF, beta-adrenergic blockers (β-blockers) have consistently been shown to reduce mortality and HF hospitalization in chronic HF with reduced ejection fraction. Proposed mechanisms include neurohormonal blockade and heart rate reduction. A new therapeutic agent now exists to target further heart rate lowering in patients who have been stable on a "maximally tolerated β-blocker dose," but this definition and how to achieve it are incompletely understood. In this review, the authors summarize published reports on the mechanisms by which β-blockers improve clinical outcomes. The authors describe differences in doses achieved in landmark clinical trials and those observed in routine clinical practice. They further discuss reasons for intolerance and the evidence behind using β-blocker dose and heart rate as therapeutic targets. Finally, the authors offer recommendations for clinicians actively initiating and up-titrating β-blockers that may aid in achieving maximally tolerated doses.

Citations

Aug 25, 2020·The Egyptian Heart Journal : (EHJ) : Official Bulletin of the Egyptian Society of Cardiology·Jeeva JosephJabir Abdullakutty
Sep 29, 2020·Scientific Reports·Yirga Legesse NiriayoKidu Gidey
Dec 12, 2018·European Journal of Heart Failure·Catherine N MartiJaved Butler
Sep 18, 2020·European Heart Journal. Cardiovascular Pharmacotherapy·Seif El HadidiAndrew J S Coats
Jan 8, 2021·International Journal of Clinical Pharmacy·Seif El HadidiMargaret Bermingham
Mar 2, 2021·Pediatric Pulmonology·Samuel G Wittekind, Chet R Villa
Aug 20, 2021·Journal of Taibah University Medical Sciences·Yoga WaranugrahaIndra J Aziz
Nov 6, 2021·The Cochrane Database of Systematic Reviews·Sanam SafiJanus C Jakobsen

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