When using a beta-blocker, the end-point should be the target heart rate, rather than the target dose. A meta-analysis of 23 RCTs was done to look into this issue of beta-blocker use in patients with heart failure. The benefits of beta-blocker use in the patients showed a linear correlation with the reduction of resting heart rate; with every 5 bpm reduction in resting heart rate, there was an 18% reduction in relative mortality risk. (Ann Intern Med 2009;Jun 2;150:784).

The use of beta-blockers in those with acute heart failure can be useful. However, one must ensure that patients are well-diuresed before the beta-blocker is started, to prevent the development of severe dyspnea secondary to pulmonary edema. More recently, a trial looking at carvedilol demonstrated no major difference between target doses achieved.

In my clinical practice, I titrate beta-blockers to a resting heart rate close to 60 bpm and pay attention to blood pressure as well as patient symptoms rather than a target dose of the drug.

ENTER KEYWORD(S)

To search a phrase, use quotation marks (e.g. "back pain")