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

Journal Article (Review)

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.

Full Text

Duke Authors

Cited Authors

  • Bhatt, AS; DeVore, AD; DeWald, TA; Swedberg, K; Mentz, RJ

Published Date

  • May 2017

Published In

Volume / Issue

  • 69 / 20

Start / End Page

  • 2542 - 2550

PubMed ID

  • 28521892

Electronic International Standard Serial Number (EISSN)

  • 1558-3597

International Standard Serial Number (ISSN)

  • 0735-1097

Digital Object Identifier (DOI)

  • 10.1016/j.jacc.2017.03.563

Language

  • eng